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Qaisar A Shah - One of the best experts on this subject based on the ideXlab platform.
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super selective intra arterial magnesium sulfate in combination with Nicardipine for the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage
Neurocritical Care, 2009Co-Authors: Qaisar A Shah, Muhammad Zeeshan Memon, Fareed M K Suri, Gustavo J Rodriguez, Osman Kozak, Robert A Taylor, Ramachandra P Tummala, Gabriela Vazquez, Alexandros L GeorgiadisAbstract:To determine the safety and tolerability of super-selective intra-arterial magnesium sulfate in combination with intra-arterial Nicardipine in patients with cerebral vasospasm after subarachnoid hemorrhage. Patients were treated in a prospective protocol at two teaching medical centers. Emergent cerebral angiography was performed if there was either clinical, ultrasound, and/or computed tomographic (CT) perfusion deficits suggestive of cerebral vasospasm. Intra-arterial magnesium sulfate (0.25–1 g) was administered via a microcatheter in the affected vessels in combination with Nicardipine (2.5–20.0 mg). Mean arterial pressures (MAP) and intracranial pressures (ICP) were monitored during the infusion. Immediate and sustained angiographic and clinical improvement was determined from post-treatment angiograms and clinical follow-up. Angiographic and clinical outcomes were compared to two published case series that has used Nicardipine alone. A total of 58 vessels were treated in 14 patients (mean age 42 years; 11 women) with acute subarachnoid hemorrhage. The treatment was either intra-arterial Nicardipine and magnesium sulfate alone or in conjunction with primary angioplasty. Forty vessels (69%) had immediate angiographic improvement with intra-arterial Nicardipine and magnesium sulfate alone and 18 vessels (31%) required concomitant balloon angioplasty with complete reversal of the vasospasm. Retreatment was required in 13 vessels (22%) and the median time for retreatment was 2 days (range 1–13 days). Nicardipine treatment resulted in the reduction of MAP (12.3 mmHg, standard error [SE] 1.34, P-value <0.0001) without any significant change in ICP. Magnesium sulfate infusion was not associated with change in MAP or ICP. Among 31 procedures, immediate neurological improvement was observed in 22 (71%) procedures. In 12 (86%) patients, there were no infarctions in the follow-up CT scan acquired between 24 and 48 h. No statistical significant difference was observed in angiographic and clinical outcome of patients treated with the combination therapy in comparison with historical controls treated with Nicardipine alone. Administration of intra-arterial magnesium sulfate in combination with Nicardipine was well tolerated in patients with subarachnoid hemorrhage and cerebral vasospasm without a significant change in MAP and ICP. The efficacy of this combination therapy should be evaluated in a larger, controlled setting.
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preliminary experience with intra arterial Nicardipine in patients with acute ischemic stroke
Neurocritical Care, 2007Co-Authors: Fareed M K Suri, Qaisar A Shah, Gustavo J Rodriguez, Alexandros L Georgiadis, Adnan I. QureshiAbstract:To report experience with intra-arterial (IA) calcium channel blocker (Nicardipine) in patients with acute ischemic stroke with and without reteplase, mechanical thrombectomy (snare), and primary angioplasty to achieve maximal recanalization. Selective delivery of calcium channel blocker may improve perfusion and possibly provide neuroprotection in cerebral ischemia. We performed a retrospective study to determine the angiographic and clinical outcomes among patients treated with IA Nicardipine administered as 2.5–5 mg dose either alone or adjunct to intra-arterial thrombolysis. Mean arterial pressure and heart rate were recorded throughout the injection. Angiographic severity of initial occlusion and recanalization was assessed using the Qureshi grading scheme. Neurological examinations and computed tomographic scans were performed prior to, immediately, and 24 h after thrombolysis for each patient, to assess the neurological improvement and symptomatic or asymptomatic intracranial hemorrhages. Ten patients median age of 60 years (age range: 35–93 years) were administered IA Nicardipine. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 14 (range 6–19). All patients received IA Nicardipine either in combination with thrombolytics (n = 6) or as monotherapy (n = 4). The average decrease in mean arterial pressure (MAP) was 10 mmHg; except one patient who had an asymptomatic decline of 34 mm Hg, which responded to fluid resuscitation. None of the patients suffered any procedural and post-procedural complication. Overall recanalization (improvement in one grade or greater) was observed in 2 of 10 patients with IA Nicardipine with or without thrombolytic treatment. Other angiographic changes observed included improvement in collateral flow (n = 2), increase in transit time (n = 1), and vasodilation of distal arteries and branches (n = 4). No patient demonstrated any worsening from the baseline grade in response to IA Nicardipine. Of the two patients who underwent serial magnetic resonance imaging (MRI) and one patient demonstrated reversal of pretreatment restricted diffusion. Neurological improvement defined by a decrease of four points or greater was observed in four patients at 24 h following treatment. Intra-arterial delivery of Nicardipine in doses up to 5 mg is well tolerated among patients with acute ischemic stroke. Further studies are required to determine the potential efficacy of this approach with or without thrombolytics.
Alexandros L Georgiadis - One of the best experts on this subject based on the ideXlab platform.
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super selective intra arterial magnesium sulfate in combination with Nicardipine for the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage
Neurocritical Care, 2009Co-Authors: Qaisar A Shah, Muhammad Zeeshan Memon, Fareed M K Suri, Gustavo J Rodriguez, Osman Kozak, Robert A Taylor, Ramachandra P Tummala, Gabriela Vazquez, Alexandros L GeorgiadisAbstract:To determine the safety and tolerability of super-selective intra-arterial magnesium sulfate in combination with intra-arterial Nicardipine in patients with cerebral vasospasm after subarachnoid hemorrhage. Patients were treated in a prospective protocol at two teaching medical centers. Emergent cerebral angiography was performed if there was either clinical, ultrasound, and/or computed tomographic (CT) perfusion deficits suggestive of cerebral vasospasm. Intra-arterial magnesium sulfate (0.25–1 g) was administered via a microcatheter in the affected vessels in combination with Nicardipine (2.5–20.0 mg). Mean arterial pressures (MAP) and intracranial pressures (ICP) were monitored during the infusion. Immediate and sustained angiographic and clinical improvement was determined from post-treatment angiograms and clinical follow-up. Angiographic and clinical outcomes were compared to two published case series that has used Nicardipine alone. A total of 58 vessels were treated in 14 patients (mean age 42 years; 11 women) with acute subarachnoid hemorrhage. The treatment was either intra-arterial Nicardipine and magnesium sulfate alone or in conjunction with primary angioplasty. Forty vessels (69%) had immediate angiographic improvement with intra-arterial Nicardipine and magnesium sulfate alone and 18 vessels (31%) required concomitant balloon angioplasty with complete reversal of the vasospasm. Retreatment was required in 13 vessels (22%) and the median time for retreatment was 2 days (range 1–13 days). Nicardipine treatment resulted in the reduction of MAP (12.3 mmHg, standard error [SE] 1.34, P-value <0.0001) without any significant change in ICP. Magnesium sulfate infusion was not associated with change in MAP or ICP. Among 31 procedures, immediate neurological improvement was observed in 22 (71%) procedures. In 12 (86%) patients, there were no infarctions in the follow-up CT scan acquired between 24 and 48 h. No statistical significant difference was observed in angiographic and clinical outcome of patients treated with the combination therapy in comparison with historical controls treated with Nicardipine alone. Administration of intra-arterial magnesium sulfate in combination with Nicardipine was well tolerated in patients with subarachnoid hemorrhage and cerebral vasospasm without a significant change in MAP and ICP. The efficacy of this combination therapy should be evaluated in a larger, controlled setting.
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preliminary experience with intra arterial Nicardipine in patients with acute ischemic stroke
Neurocritical Care, 2007Co-Authors: Fareed M K Suri, Qaisar A Shah, Gustavo J Rodriguez, Alexandros L Georgiadis, Adnan I. QureshiAbstract:To report experience with intra-arterial (IA) calcium channel blocker (Nicardipine) in patients with acute ischemic stroke with and without reteplase, mechanical thrombectomy (snare), and primary angioplasty to achieve maximal recanalization. Selective delivery of calcium channel blocker may improve perfusion and possibly provide neuroprotection in cerebral ischemia. We performed a retrospective study to determine the angiographic and clinical outcomes among patients treated with IA Nicardipine administered as 2.5–5 mg dose either alone or adjunct to intra-arterial thrombolysis. Mean arterial pressure and heart rate were recorded throughout the injection. Angiographic severity of initial occlusion and recanalization was assessed using the Qureshi grading scheme. Neurological examinations and computed tomographic scans were performed prior to, immediately, and 24 h after thrombolysis for each patient, to assess the neurological improvement and symptomatic or asymptomatic intracranial hemorrhages. Ten patients median age of 60 years (age range: 35–93 years) were administered IA Nicardipine. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 14 (range 6–19). All patients received IA Nicardipine either in combination with thrombolytics (n = 6) or as monotherapy (n = 4). The average decrease in mean arterial pressure (MAP) was 10 mmHg; except one patient who had an asymptomatic decline of 34 mm Hg, which responded to fluid resuscitation. None of the patients suffered any procedural and post-procedural complication. Overall recanalization (improvement in one grade or greater) was observed in 2 of 10 patients with IA Nicardipine with or without thrombolytic treatment. Other angiographic changes observed included improvement in collateral flow (n = 2), increase in transit time (n = 1), and vasodilation of distal arteries and branches (n = 4). No patient demonstrated any worsening from the baseline grade in response to IA Nicardipine. Of the two patients who underwent serial magnetic resonance imaging (MRI) and one patient demonstrated reversal of pretreatment restricted diffusion. Neurological improvement defined by a decrease of four points or greater was observed in four patients at 24 h following treatment. Intra-arterial delivery of Nicardipine in doses up to 5 mg is well tolerated among patients with acute ischemic stroke. Further studies are required to determine the potential efficacy of this approach with or without thrombolytics.
Fareed M K Suri - One of the best experts on this subject based on the ideXlab platform.
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super selective intra arterial magnesium sulfate in combination with Nicardipine for the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage
Neurocritical Care, 2009Co-Authors: Qaisar A Shah, Muhammad Zeeshan Memon, Fareed M K Suri, Gustavo J Rodriguez, Osman Kozak, Robert A Taylor, Ramachandra P Tummala, Gabriela Vazquez, Alexandros L GeorgiadisAbstract:To determine the safety and tolerability of super-selective intra-arterial magnesium sulfate in combination with intra-arterial Nicardipine in patients with cerebral vasospasm after subarachnoid hemorrhage. Patients were treated in a prospective protocol at two teaching medical centers. Emergent cerebral angiography was performed if there was either clinical, ultrasound, and/or computed tomographic (CT) perfusion deficits suggestive of cerebral vasospasm. Intra-arterial magnesium sulfate (0.25–1 g) was administered via a microcatheter in the affected vessels in combination with Nicardipine (2.5–20.0 mg). Mean arterial pressures (MAP) and intracranial pressures (ICP) were monitored during the infusion. Immediate and sustained angiographic and clinical improvement was determined from post-treatment angiograms and clinical follow-up. Angiographic and clinical outcomes were compared to two published case series that has used Nicardipine alone. A total of 58 vessels were treated in 14 patients (mean age 42 years; 11 women) with acute subarachnoid hemorrhage. The treatment was either intra-arterial Nicardipine and magnesium sulfate alone or in conjunction with primary angioplasty. Forty vessels (69%) had immediate angiographic improvement with intra-arterial Nicardipine and magnesium sulfate alone and 18 vessels (31%) required concomitant balloon angioplasty with complete reversal of the vasospasm. Retreatment was required in 13 vessels (22%) and the median time for retreatment was 2 days (range 1–13 days). Nicardipine treatment resulted in the reduction of MAP (12.3 mmHg, standard error [SE] 1.34, P-value <0.0001) without any significant change in ICP. Magnesium sulfate infusion was not associated with change in MAP or ICP. Among 31 procedures, immediate neurological improvement was observed in 22 (71%) procedures. In 12 (86%) patients, there were no infarctions in the follow-up CT scan acquired between 24 and 48 h. No statistical significant difference was observed in angiographic and clinical outcome of patients treated with the combination therapy in comparison with historical controls treated with Nicardipine alone. Administration of intra-arterial magnesium sulfate in combination with Nicardipine was well tolerated in patients with subarachnoid hemorrhage and cerebral vasospasm without a significant change in MAP and ICP. The efficacy of this combination therapy should be evaluated in a larger, controlled setting.
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a multicenter comparison of outcomes associated with intravenous nitroprusside and Nicardipine treatment among patients with intracerebral hemorrhage
Neurocritical Care, 2009Co-Authors: Fareed M K Suri, Gabriela Vazquez, Mustapha A Ezzeddine, Adnan I. QureshiAbstract:No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission. We analyzed one-year data (2005–2006) from the Premier database which is a nationally representative hospital discharge database containing data pertaining to admissions in the United States. We compared discharge outcomes, length of stay, and cost of hospitalization between groups of patients who were treated using either intravenous Nicardipine or nitroprusside infusion. Chi-square and ANOVA were used for univariate analysis. Logistic and linear regression analyses were performed to adjust for baseline risk of mortality between the two groups. A total of 12,767 admissions with primary diagnosis of ICH were identified. Nicardipine was administered in 926 patients (7.3%) and nitroprusside was administered in 530 (4.3%) patients. There was no difference in baseline disease severity or risk of mortality among patients who were administered Nicardipine or nitroprusside. After adjustment for baseline risk of mortality, the risk of in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [95% CI] 1.3–2.2) was higher among patients treated with nitroprusside compared with Nicardipine. The risk of in-hospital mortality was also higher after adjustment for baseline risk of mortality and hospital characteristics in patients treated with nitroprusside (OR 1.6, 95% CI 1.2–2.1). After exclusion of patients who died during hospitalization, there was no difference in length of stay and total hospital cost in the multivariate analysis. Use of Nicardipine compared with nitroprusside infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.
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preliminary experience with intra arterial Nicardipine in patients with acute ischemic stroke
Neurocritical Care, 2007Co-Authors: Fareed M K Suri, Qaisar A Shah, Gustavo J Rodriguez, Alexandros L Georgiadis, Adnan I. QureshiAbstract:To report experience with intra-arterial (IA) calcium channel blocker (Nicardipine) in patients with acute ischemic stroke with and without reteplase, mechanical thrombectomy (snare), and primary angioplasty to achieve maximal recanalization. Selective delivery of calcium channel blocker may improve perfusion and possibly provide neuroprotection in cerebral ischemia. We performed a retrospective study to determine the angiographic and clinical outcomes among patients treated with IA Nicardipine administered as 2.5–5 mg dose either alone or adjunct to intra-arterial thrombolysis. Mean arterial pressure and heart rate were recorded throughout the injection. Angiographic severity of initial occlusion and recanalization was assessed using the Qureshi grading scheme. Neurological examinations and computed tomographic scans were performed prior to, immediately, and 24 h after thrombolysis for each patient, to assess the neurological improvement and symptomatic or asymptomatic intracranial hemorrhages. Ten patients median age of 60 years (age range: 35–93 years) were administered IA Nicardipine. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 14 (range 6–19). All patients received IA Nicardipine either in combination with thrombolytics (n = 6) or as monotherapy (n = 4). The average decrease in mean arterial pressure (MAP) was 10 mmHg; except one patient who had an asymptomatic decline of 34 mm Hg, which responded to fluid resuscitation. None of the patients suffered any procedural and post-procedural complication. Overall recanalization (improvement in one grade or greater) was observed in 2 of 10 patients with IA Nicardipine with or without thrombolytic treatment. Other angiographic changes observed included improvement in collateral flow (n = 2), increase in transit time (n = 1), and vasodilation of distal arteries and branches (n = 4). No patient demonstrated any worsening from the baseline grade in response to IA Nicardipine. Of the two patients who underwent serial magnetic resonance imaging (MRI) and one patient demonstrated reversal of pretreatment restricted diffusion. Neurological improvement defined by a decrease of four points or greater was observed in four patients at 24 h following treatment. Intra-arterial delivery of Nicardipine in doses up to 5 mg is well tolerated among patients with acute ischemic stroke. Further studies are required to determine the potential efficacy of this approach with or without thrombolytics.
Adnan I. Qureshi - One of the best experts on this subject based on the ideXlab platform.
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Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
Annals of neurology, 2020Co-Authors: Andrew D. Warren, Adnan I. Qureshi, Andrea Morotti, Guido J. Falcone, Kevin N. Sheth, Ashkan Shoamanesh, Dar Dowlatshahi, Anand Viswanathan, Joshua N. GoldsteinAbstract:Objective The aim was to investigate whether intensive blood pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous Nicardipine treatment ≤2 hours after onset of symptoms. Methods A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard blood pressure treatment with Nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis. Results Among the 913 included patients, 354 (38.7%) had intravenous Nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive blood pressure reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive blood pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34-0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28-3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01-2.83; p = 0.048) at 90 days. Ultra-early intensive blood pressure reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04). Interpretation In a subgroup of ICH patients with elevated blood pressure given intravenous Nicardipine ≤2 hours after onset of symptoms, intensive blood pressure reduction was associated with reduced hematoma growth and improved functional outcome. ANN NEUROL 2020;88:388-395.
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a multicenter comparison of outcomes associated with intravenous nitroprusside and Nicardipine treatment among patients with intracerebral hemorrhage
Neurocritical Care, 2009Co-Authors: Fareed M K Suri, Gabriela Vazquez, Mustapha A Ezzeddine, Adnan I. QureshiAbstract:No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission. We analyzed one-year data (2005–2006) from the Premier database which is a nationally representative hospital discharge database containing data pertaining to admissions in the United States. We compared discharge outcomes, length of stay, and cost of hospitalization between groups of patients who were treated using either intravenous Nicardipine or nitroprusside infusion. Chi-square and ANOVA were used for univariate analysis. Logistic and linear regression analyses were performed to adjust for baseline risk of mortality between the two groups. A total of 12,767 admissions with primary diagnosis of ICH were identified. Nicardipine was administered in 926 patients (7.3%) and nitroprusside was administered in 530 (4.3%) patients. There was no difference in baseline disease severity or risk of mortality among patients who were administered Nicardipine or nitroprusside. After adjustment for baseline risk of mortality, the risk of in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [95% CI] 1.3–2.2) was higher among patients treated with nitroprusside compared with Nicardipine. The risk of in-hospital mortality was also higher after adjustment for baseline risk of mortality and hospital characteristics in patients treated with nitroprusside (OR 1.6, 95% CI 1.2–2.1). After exclusion of patients who died during hospitalization, there was no difference in length of stay and total hospital cost in the multivariate analysis. Use of Nicardipine compared with nitroprusside infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.
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preliminary experience with intra arterial Nicardipine in patients with acute ischemic stroke
Neurocritical Care, 2007Co-Authors: Fareed M K Suri, Qaisar A Shah, Gustavo J Rodriguez, Alexandros L Georgiadis, Adnan I. QureshiAbstract:To report experience with intra-arterial (IA) calcium channel blocker (Nicardipine) in patients with acute ischemic stroke with and without reteplase, mechanical thrombectomy (snare), and primary angioplasty to achieve maximal recanalization. Selective delivery of calcium channel blocker may improve perfusion and possibly provide neuroprotection in cerebral ischemia. We performed a retrospective study to determine the angiographic and clinical outcomes among patients treated with IA Nicardipine administered as 2.5–5 mg dose either alone or adjunct to intra-arterial thrombolysis. Mean arterial pressure and heart rate were recorded throughout the injection. Angiographic severity of initial occlusion and recanalization was assessed using the Qureshi grading scheme. Neurological examinations and computed tomographic scans were performed prior to, immediately, and 24 h after thrombolysis for each patient, to assess the neurological improvement and symptomatic or asymptomatic intracranial hemorrhages. Ten patients median age of 60 years (age range: 35–93 years) were administered IA Nicardipine. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 14 (range 6–19). All patients received IA Nicardipine either in combination with thrombolytics (n = 6) or as monotherapy (n = 4). The average decrease in mean arterial pressure (MAP) was 10 mmHg; except one patient who had an asymptomatic decline of 34 mm Hg, which responded to fluid resuscitation. None of the patients suffered any procedural and post-procedural complication. Overall recanalization (improvement in one grade or greater) was observed in 2 of 10 patients with IA Nicardipine with or without thrombolytic treatment. Other angiographic changes observed included improvement in collateral flow (n = 2), increase in transit time (n = 1), and vasodilation of distal arteries and branches (n = 4). No patient demonstrated any worsening from the baseline grade in response to IA Nicardipine. Of the two patients who underwent serial magnetic resonance imaging (MRI) and one patient demonstrated reversal of pretreatment restricted diffusion. Neurological improvement defined by a decrease of four points or greater was observed in four patients at 24 h following treatment. Intra-arterial delivery of Nicardipine in doses up to 5 mg is well tolerated among patients with acute ischemic stroke. Further studies are required to determine the potential efficacy of this approach with or without thrombolytics.
Johnny C Pryor - One of the best experts on this subject based on the ideXlab platform.
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intra arterial Nicardipine infusion improves ct perfusion measured cerebral blood flow in patients with subarachnoid hemorrhage induced vasospasm
American Journal of Neuroradiology, 2008Co-Authors: Raul G Nogueira, James D Rabinov, Christopher S Ogilvy, Guy Rordorf, Luca Roccatagliata, Joshua A Hirsch, R G Gonzalez, Elkan F Halpern, Johnny C PryorAbstract:BACKGROUND AND PURPOSE: Our aim was to determine the effects of intra-arterial (IA) Nicardipine infusion on the cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH)–induced vasospasm by using first-pass quantitative cine CT perfusion (CTP). MATERIALS AND METHODS: Six patients post-aSAH with clinical and transcranial Doppler findings suggestive of vasospasm were evaluated by CT angiography and CTP immediately before angiography for possible vasospasm treatment. CTP was repeated immediately following IA Nicardipine infusion. Maps of mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were constructed and analyzed in a blinded manner. Corresponding regions of interest on these maps from the bilateral middle cerebral artery territories and, when appropriate, the bilateral anterior or posterior cerebral artery territories, were selected from the pre- and posttreatment scans. Normalized values were compared by repeated measures analysis of variance. RESULTS: Angiographic vasospasm was confirmed in all patients. In 5 of the 6 patients, both CBF and MTT improved significantly in affected regions in response to Nicardipine therapy (mean increase in CBF, 41 ± 43%; range, −9%–162%, P = .0004; mean decrease in MTT, 26 ± 24%; range, 0%–70%, P = .0002). In 1 patient, we were unable to quantify improvement in flow parameters due to section-selection differences between the pre- and posttreatment examinations. CONCLUSIONS: IA Nicardipine improves CBF and MTT in ischemic regions in patients with aSAH-induced vasospasm. Our data provide a tissue-level complement to the favorable effects of IA Nicardipine reported on prior angiographic studies. CTP may provide a surrogate marker for monitoring the success of treatment strategies in patients with aSAH-induced vasospasm.
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preliminary experience with intra arterial Nicardipine as a treatment for cerebral vasospasm
American Journal of Neuroradiology, 2004Co-Authors: Neeraj Badjatia, Mehmet Akif Topcuoglu, Johnny C Pryor, James D Rabinov, Christopher S Ogilvy, Bob S Carter, Guy RordorfAbstract:BACKGROUND AND PURPOSE: Papaverine is the primary intra-arterial (IA) treatment for vasospasm after aneurysmal subarachnoid hemorrhage (SAH); however, is it limited in effect and by adverse effects. We prospectively studied the use of IA Nicardipine as a treatment for vasospasm. METHODS: Over 12 months, all patients with SAH who required interventional treatment for vasospasm were given IA Nicardipine with or without angioplasty. Vasospasm was determined by serial clinical assessments and/or daily transcranial Doppler (TCD) imaging and confirmed by angiography. Doses of IA Nicardipine per vessel were 0.5-6 mg. All patients were monitored for increased intracranial pressure (ICP) and change in cardiovascular or neurologic status. RESULTS: Forty-four vessels in 18 patients with vasospasm were treated with IA Nicardipine alone. TCD data for 38 vessels (15 cases) were available. All vessels demonstrated immediate angiographic dilatation after IA Nicardipine. No sustained cardiovascular changes were after treatment. ICP was transiently elevated in five patients and persistently elevated in one. Mean peak systolic velocities at TCD imaging were significantly reduced from pretreatment values in all treated vessels for 4 days after infusion (268.9 +/- 77.8 vs 197.6 +/- 74.1 cm/s, P <.001). Neurologic improvement after IA Nicardipine occurred in eight (42.1%) patients. No clinical deterioration was noted. CONCLUSION: As shown by TCD imaging, IA Nicardipine has an immediate and sustained effect on vasospasm. It does not appear to have sustained effect on ICP or cardiovascular status. This treatment warrants further study to determine its safety and efficacy.