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Nicardipine pellets for the prevention of cerebral vasospasm.
MedLine Citation:
PMID:  21125473     Owner:  NLM     Status:  In-Process    
Regardless of numerous efforts there is no prophylactic treatment proven to be effective in the prevention of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). As systemic administration of vasoactive drugs has been associated with significant side effects and insufficient efficacy, intrathecal administration of nicardipine prolonged-release implants (NPRI) has been developed. At the time of surgical clipping of the ruptured aneurysm, NPRIs are positioned next to the large cerebral arteries. Several clinical protocols revealed that NPRIs dramatically reduce the incidence and severity of angiographic vasospasm, which was paralled by a reduction in cerebral infarction and delayed ischemic neurologic deficit. On average, the incidence of angiographic vasospasm decreased from approximately 70% to less than 10%. Efficacy seemed to be dose-dependent and reduced for peripheral vasospasm. Nevertheless, a significant improvement of functional outcome was demonstrated. A separate patient series demonstrated the efficacy of fewer NPRIs in the perichiasmatic cistern. Further investigations were performed in comparison to coiled patients and with intraventricular implantation of NPRIs, which had a less pronounced effect. Overall, NPRIs are a most promising option for the prevention of cerebral vasospasm after SAH and large controlled trials are needed to further confirm these results.
Claudius Thomé; Marcel Seiz; Gerrit Alexander Schubert; Martin Barth; Peter Vajkoczy; Hidetoshi Kasuya; Peter Schmiedek
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  110     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2011  
Date Detail:
Created Date:  2010-12-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  209-11     Citation Subset:  IM    
Department of Neurosurgery, Innsbruck Medical University, Anichstr. 35, A-6020, Innsbruck, Austria.
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