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Effects of prophylactic intrathecal administrations of nicardipine on vasospasm in patients with severe aneurysmal subarachnoid haemorrhage

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Summary

Calcium antagonists are currently most widely used for chronic cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH). However, the vasodilatory effects of systemically administered calcium antagonists can be limited secondary to hypotension. We previously compared intrathecal and intravenous routes of administration of nicardipine. Intrathecal administration of nicardipine significantly dilated spastic basilar arteries on day 7 in a two-haemorrhage canine model of vasospasm.

In the present communication, the effects of prophylactic, serial administration of intrathecal nicardipine on vasospasm was examined in 50 patients. Patients were classified as Fisher SAH group 3 and all had their aneurysms clipped within 3 days of SAH. Following placement of a cisternal drain, 2 mg of nicardipine was injected, three times each day for an average of 10 days. The control group consisted of 91 similar patients with cisternal drainage not treated with nicardipine.

Intrathecal administration of nicardipine decreased the incidence of symptomatic vasospasm by 26%, angiographic vasospasm by 20% and increased good clinical outcome at one month after the haemorrhage by 15%. Postoperative angiograms revealed that patients in the nicardipine group showed less vasospasm of major cerebral arteries, near the tip of a drain in the basal cistern, but vasospasm in the A2 and M2 segments was not decreased. Radio-isotope cisternography suggested that nicardipine might not reach the subarachnoid space around A2 and M2 segments. Nine patients complained of headache probably secondary to nicardipine induced vasodilation. Two patients suffered from mengingitis, both were successfully treated.

Intrathecal administration nicardipine appears to be effective in the treatment of vasospasm, but side effects were significant.

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References

  1. Asano T, Ikegaki I, Satoh S, Suzuki Y, Shibuya M, Takayasu M, Hidaka H (1987) Mechanism of action of a novel antivasospasm drug, HA 1077. J Pharmacol Exp Ther 241: 1033–1040

    PubMed  Google Scholar 

  2. Auer LM, Ito Z, Suzuki A, Ohta H (1982) Prevention of symptomatic vasospasm by topically applied nimodipine. Acta Neurochir (Wien) 63: 297–302

    Google Scholar 

  3. Cheung JY, Bonventre JV, Malis CD, Leaf A (1986) Calcium and ischemic injury. N Engl J Med 314: 1670–1676

    PubMed  Google Scholar 

  4. Espinosa F. Weir B, Overton T, Castor W, Grace M, Boisvert D (1984) A randomized placebo-controlled double blind trial of nimodipine after SAH in monkeys. Part I: clinical and radiological findings. J Neurosurg 60: 1167–1175

    PubMed  Google Scholar 

  5. Gaab MR, Czech T, Korn A (1985) Intracranial effects of nicardipine. Br J Clin Pharmacol 20: 67 S-74 S

    Google Scholar 

  6. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computed tomographic scanning. Neurosurgery 6: 1–9

    PubMed  Google Scholar 

  7. Gioia AE, White RP, Bakhtian B, Robertson JT (1985) Evaluation of the efficacy of intrathecal nimodipine in canine models of chronic cerebral vasospasm. J Neurosurg 62: 721–728

    PubMed  Google Scholar 

  8. Grotenhuis JA, Bettag W, Fiebach BJO, Dabir K (1984) Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. J Neurosurg 61: 231–240

    PubMed  Google Scholar 

  9. Haley EC Jr, Kassell NF, Torner JC, The Participants (1993) A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. A report of the cooperative aneurysm study. J Neurosurg 78: 537–547

    PubMed  Google Scholar 

  10. Handa J, Yoneda S, Koyama T, Matsuda M, Handa H (1975) Experimental cerebral vasospasm in cats: modification by a new synthetic vasodilator (YC-93). Surg Neurol 3: 195–199

    PubMed  Google Scholar 

  11. Hillman J, Bynke O, Westergren H (1991) Nimodipine evoked dilation of cerebral arteries early during the development of late vasospasm in subarachnoid hemorrhage. Neurochirurgia 34: 157–159.

    PubMed  Google Scholar 

  12. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    PubMed  Google Scholar 

  13. Hunt WE, Kassell N, Pertuiset B, Sano K, Teasdale G, de Villier J, Drake CG (1988) Report of the World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Haemorrhage Grading Scale. J Neurosurg 68: 985–986

    PubMed  Google Scholar 

  14. Jennett B, Bond MR (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484

    PubMed  Google Scholar 

  15. Kaku Y, Yonekawa Y, Tsukahara T, Kazekawa K (1993) Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77: 842–847

    Google Scholar 

  16. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL, Participants (1990) The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg 73: 18–36

    PubMed  Google Scholar 

  17. Lewis PJ, Weir BKA, Nosko MG, Tanabe T, Grace MG (1988) Intrathecal nimodipine therapy in a primate model of chronic cerebral vasospasm. Neurosurgery 22: 492–500

    PubMed  Google Scholar 

  18. Mizoi K, Yoshimoto T, Takahashi A, Fujiwara S, Koshu K, Sugawara T (1993) Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissuetype plasminogen activator. J Neurosurg 78: 430–437

    PubMed  Google Scholar 

  19. Mohamed AA, Mendelow AD, Teasdale GM, Harper AM, McCulloch J (1985) Effects of the calcium antagonist nimodipine on local cerebral blood flow and metabolic coupling. J Cereb Blood Flow Metab 5: 26–33

    PubMed  Google Scholar 

  20. Ogura K, Hara M, Tosaki F, Hirai N (1988) Effect of cisternal drainage after early operation for ruptured intracranial aneurysms. Surg Neurol 30: 441–444

    PubMed  Google Scholar 

  21. Oki S, Kobayashi M, Yoshihara T, Yamada K, Sakoda K, Uozumi T (1987) Effect of cisternal administration of nicardipine hydrochloride on cerebral vasospasm. A preliminary report. Hiroshima J Med Sci 36: 75–79

    PubMed  Google Scholar 

  22. Pasqualin A, Vollmer DG, Marron JA, Tsukahara T, Kassell NF, Torner JC (1991) The effects of nicardipine on vasospasm in rabbit basilar artery after subarachnoid hemorrhage. Neurosurgery 29: 183–188

    PubMed  Google Scholar 

  23. Petruk KC, West M, Mohr G, Weir BKA, Benoit BG, Gentili F, Disney GS, Tucker WS, Purves GB, Miller JDR, Hunter KM, Richard MT, Durity FA, Chan R, Clein LJ, Maroun FB, Godon A (1988) Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo-con-trolled trial. J Neurosurg 68: 505–517

    PubMed  Google Scholar 

  24. Pickard JD, Murray GD, Illingworth R, Shaw MDM, Teasdale GM, Foy PM, Humphrey PRD, Lang DA, Nelson R, Richards P, Sinar J, Baileyn S, Skene A (1989) Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 298: 636–642

    PubMed  Google Scholar 

  25. Shibuya M, Suzuki Y, Sugita K, Sasaki T, Saito I, Takakura K, Nagata I, Kikuchi H, Takemae T, Hidaka H, Nakashima M (1992) Effect of AT 877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. J Neurosurg 76: 571–577

    PubMed  Google Scholar 

  26. Shibuya M, Suzuki Y, Takayasu M, Asano T, Ikegaki I, Sugita K (1994) Effects of intrathecal administration nicardipine and nifedipine on chronic cerebral vasospasm in dogs. J Clin Neurosci 1: 58–61

    Google Scholar 

  27. Siesjo BK (1992) Pathophysiology and treatment of focal cerebral ischemia. Part I: pathophysiology. J Neurosurg 77: 169–184

    PubMed  Google Scholar 

  28. Takayasu M, Suzuki Y, Shibuya M, Asano T, Kanamori M, Okada T, Kageyama N, Hidaka H (1986) The effects of HA compound calcium antagonists on delayed cerebral vasospasm in dogs. J Neurosurg 65: 80–85

    PubMed  Google Scholar 

  29. Toyota A, Nishizawa Y (1991) Cerebral vasospasm after subaracnoid hemorrhage and inhibitory effect of nicardipine investigated by means of transcranial doppler ultrasonography. Neurol Surg (Jpn) 19: 1143–1150

    Google Scholar 

  30. Varsos VG, Liszczak TM, Han DH, Kistler JP, Vielma J, Black PM, Heros RC, Zervas NT (1983) Delayed cerebral vasospasm is not reversible by aminophylline, nifedipine, or papaverine in a “two-hemorrhage” canine model. J Neurosurg 58: 11–17

    PubMed  Google Scholar 

  31. Voldby B, Peterson OF, Buhl M, Jakobsen P, Ostergaard R (1984) Reversal of cerebral arterial spasm by intrathecal administration of a calcium antagonist (Nimodipine). Acta Neurochir (Wien) 70: 243–254

    Google Scholar 

  32. Vorkapic P, Bevan RD, Bevan JA (1991) Longitudinal time course of reversible and irreversible components of chronic cerebrovasospasm of the rabbit basilar artery. J Neurosurg 74: 951–955

    PubMed  Google Scholar 

  33. Weir B (1984) Calcium antagonists, cerebral ischemia and vasospasm. Can J Neurol Sci 11: 239–246

    PubMed  Google Scholar 

  34. Zabramski J, Spetzler RF, Bonstelle C (1986) Chronic cerebral vasospasm: effect of calcium antagonists. Neurosurgery 18: 129–135

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University, Nagoya, Japan

    K. Sugita

  2. Chubu Rosai Hospital, Nagoya, Japan

    M. Shibuya, Y. Suzuki & H. Enomoto

  3. Nagoya 2nd Red Cross Hospital, Nagoya, Japan

    T. Okada

  4. Ichinomiya City Hospital, Nagoya, Japan

    K. Ogura

Authors
  1. M. Shibuya
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  2. Y. Suzuki
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  3. H. Enomoto
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  4. T. Okada
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  5. K. Ogura
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  6. K. Sugita
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Shibuya, M., Suzuki, Y., Enomoto, H. et al. Effects of prophylactic intrathecal administrations of nicardipine on vasospasm in patients with severe aneurysmal subarachnoid haemorrhage. Acta neurochir 131, 19–25 (1994). https://doi.org/10.1007/BF01401450

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