Artikel
Effect of intraventricular nicardipine prolonged release implants on clinical and radiological outcome in patients following aneurysmal SAH
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Autoren
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Martin Barth
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland
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Pablo Pena
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland
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Marcel Seiz
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland
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Claudius Thomé
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland
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Elke Muench
- Institut für Anesthesie and Intensivmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland
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Stephan Weidauer
- Neuroradiologische Klinik, Johann-Wolfgang-Goethe Universität Frankfurt, Deutschland
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Elke Hattingen
- Neuroradiologische Klinik, Johann-Wolfgang-Goethe Universität Frankfurt, Deutschland
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Hidetoshi Kasuya
- Neurochirurgische Klinik, Tokyo Women's Medical University, Tokyo, Japan
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Peter Schmiedek
- Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Intracisternal nicardipine prolonged release implants (NPRI) have been shown to be highly effective in the prophylaxis of cerebral vasospasm (VS). However, they cannot be used in patients following coil occlusion of the aneurysm. Although a certain dissemination of nicardipine within the CSF has been described, it is unclear to what extent intraventricular NPRI are capable to prevent vasospasm, development of cerebral infarction and clinical deterioration following aneurysmal subarachnoid hemorrhage (aSAH).
Methods: 47 patients suffering from aSAH were analyzed for this trial. Patients of the treatment group were prospectively included and received prior to clipping (n=17) or coiling (n=14) 6 (n=15) or 10 (n=16) NPRI into the lateral ventricles. The control group represents a historical group of 16 operated patients that were left without NPRI implantation. Proximal and global VS was determined using preoperative and day 8±1 angiography. CT imaging was performed preoperatively and at days 2 and 10 for detection of VS related infarcts. Patient outcome was assessed using the extended Glasgow outcome (GOSE) and the modified Rankin scales (mRankin).
Results: With intraventricular NPRI, proximal vessel diameters showed a trend to increase in a dose dependent fashion (Control, 80%±30, 6 NPRI 83%±29, 10 NPRI 86%±33). Likewise, the incidence of moderate/severe global VS was decreased (Control, 73%; 6 NPRI, 53%; 10 NPRI, 48%). This effect was significant for clipped patients only both for proximal vessel diameters (clip, 90%±29; coil 82%±38) and the incidence of moderate/severe global VS (clip, 41%, coil, 57%). Patients with NPRI showed less VS related infarcts and better outcome scores.
Conclusions: The use of intraventricular NPRI lowers dose-dependently the degree of angiographic VS, the incidence of cerebral infarction and leads to clinical improvement, which is significant for clipped patients only. The prophylactic effect of intraventricular NPRI might be further increased with a higher effective dose of nicardipine.
