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A Simplified Method for Administration of Intra-Arterial Nicardipine for Vasospasm With Cervical Catheter Infusion

Pandey, Paritosh MD*; Steinberg, Gary K. MD, PhD*; Dodd, Robert MD, PhD; Do, Huy M. MD; Marks, Michael P. MD

doi: 10.1227/NEU.0b013e3182426257
Technique Assessment

BACKGROUND: Cerebral vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage. Nicardipine has previously been used to treat vasospasm through superselective intracranial microcatheter injections.

OBJECTIVE: To evaluate a simple method of treatment of vasospasm with slow infusion of nicardipine from a cervical catheter.

METHODS: Twenty-seven patients with symptomatic vasospasm were treated over 4 years with cervical catheter infusions. Nicardipine was infused at 20 mg/h for 30 to 60 minutes. Angioplasty was used in severe cases at the operator's discretion. Outcome at discharge and follow-up was evaluated with Glasgow Outcome Scale.

RESULTS: Twenty-seven patients (17 women, 12 men) received intra-arterial therapy for vasospasm. Vasospasm treatment was done at a mean post-hemorrhage date of 7.2 days (range, 4-15 days). They underwent 48 sessions of treatment (mean, 1.8 per patient) in 72 separate arterial territories. Twelve patients underwent multiple treatments. The mean dose used per session was 19.2 mg (range, 5-50 mg). Four patients underwent angioplasty for severe vasospasm. Twenty-two patients (81.5%) had clinical improvement after the infusion. Angiographic improvement was seen in 86.1% of the vessels analyzed, which had moderate or severe spasm before infusion. Overall, 17 patients (62.9%) had good outcome (Glasgow Outcome Scale score, 4 and 5) at discharge, 11 had poor outcome, and 1 patient died. Follow-up was available in 19 patients, and 18 were doing well (Glasgow Outcome Scale score, 4 and 5).

CONCLUSION: Intra-arterial nicardipine is an effective and safe treatment for cerebral vasospasm. In most patients, infusion can be performed from the cervical catheter, with microcatheter infusion and angioplasty reserved for the more severe and resistant cases.

ABBREVIATIONS: ACA, anterior cerebral artery

aSAH, aneurysmal subarachnoid hemorrhage

GOS, Glasgow Outcome Scale

ICA, internal carotid artery

ICP, intracranial pressure

MAP, mean arterial pressure

MCA, middle cerebral artery

PTA, percutaneous transluminal angioplasty

TCD, transcranial Doppler

triple-H, therapy, hypervolemia, hypertension, and hemodilution

Departments of *Neurosurgery and

Radiology and Neurosurgery, Stanford University School of Medicine, Stanford, California

Correspondence: Michael P. Marks, MD, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105. E-mail:

Received December 14, 2010

Accepted November 1, 2011

Copyright © by the Congress of Neurological Surgeons