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Systematic Review of Intrathecal Nicardipine for the Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

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Abstract

Intrathecal nicardipine has been shown to have some efficacy for the treatment of symptomatic cerebral vasospasm in aneurysmal subarachnoid hemorrhage (aSAH). We performed a PRISMA-based systematic review of intrathecal nicardipine for the treatment of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. A total of 825 articles were reviewed. After duplicates were removed and the search criteria was applied, 9 articles remained that were eligible for inclusion and analysis. 377 patients received a total of 6,596 injections of intrathecal nicardipine for aSAH-related cerebral vasospasm. The cumulative ventriculostomy-associated infection risk was 6%. Intrathecal nicardipine injections for aSAH-related cerebral vasospasm appears efficacious and safe. Administration of 4 mg of nicardipine every 12 hours was the most commonly reported dosing regimen. Intrathecal nicardipine decreases mean flow velocities on transcranial Doppler and reduces angiographic and clinical vasospasm. The infection risk appears to be in-line with studies in which rates of EVD-related infections have been reported.

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The authors received no support for this contribution.

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Authors and Affiliations

  1. Neurocritical Care, Department of Neurosurgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Shaheryar Hafeez

  2. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA

    Ramesh Grandhi

Authors
  1. Shaheryar Hafeez
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  2. Ramesh Grandhi
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Contributions

SH and RG contributed equally to the design of the study. SH performed the preliminary data analysis with confirmation by RG. SH and RG equally contributed to the analysis of the results and writing of the manuscript.

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Correspondence to Shaheryar Hafeez.

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Hafeez, S., Grandhi, R. Systematic Review of Intrathecal Nicardipine for the Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 31, 399–405 (2019). https://doi.org/10.1007/s12028-018-0659-9

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  • DOI: https://doi.org/10.1007/s12028-018-0659-9

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