OBJECTIVE: Since October 1999, nicardipine prolonged-release implants (NPRIs) have been used to prevent vasospasm in patients with subarachnoid hemorrhage. This study was conducted to examine the incidence of cerebral vasospasm and outcome after the application of NPRIs. METHODS: Ninety-seven consecutive patients among 125 patients with subarachnoid hemorrhage who were surgically treated within 72 hours were analyzed. NPRIs were applied principally to patients with thick clots (Fisher Group 3) through a frontotemporal or frontal craniotomy. Sixty-nine patients, including five in Fisher Group 2, were treated with NPRIs, and 28 were not. NPRIs were placed in the cisterns of thick clots where vasospasm was highly probable. RESULTS: Four (6%) of the 69 patients treated with NPRIs and 3 (11%) of the 28 patients not treated with NPRIs developed delayed ischemic neurological deficits (DINDs). Of these patients, clinical deterioration with infarction occurred in two patients (3%). Current smoking (P = 0.0088) and intraventricular hemorrhage on admission computed tomographic (CT) scans (P = 0.0077) were correlated with DIND. CT groupings on admission and postoperatively were not correlated, nor were World Federation of Neurosurgical Societies grades. Hypertension was inversely correlated with DIND (P = 0.0233). Eighty-six patients (89%) had an independent status at 3 months. Logistic regression analysis demonstrated that age (odds ratio [OR], 6.836; P = 0.034), World Federation of Neurosurgical Societies grade (OR, 23.317; P = 0.001), intraventricular hemorrhage on admission CT scans (OR, 6.332; P = 0.024), and surgical complications (OR, 32.861; P = 0.003) were independent risk factors influencing an unfavorable outcome. CT grouping on admission and DIND were not. CONCLUSION: Our findings suggest that the incidence of DIND may decrease and, therefore, an unfavorable outcome may improve if NPRIs are applied for patients with thick clots (Fisher Group 3) during surgery.
OBJECTIVE: Since October 1999, nicardipine prolonged-release implants (NPRIs) have been used to prevent vasospasm in patients with subarachnoid hemorrhage. This study was conducted to examine the incidence of cerebral vasospasm and outcome after the application of NPRIs. METHODS: Ninety-seven consecutive patients among 125 patients with subarachnoid hemorrhage who were surgically treated within 72 hours were analyzed. NPRIs were applied principally to patients with thick clots (Fisher Group 3) through a frontotemporal or frontal craniotomy. Sixty-nine patients, including five in Fisher Group 2, were treated with NPRIs, and 28 were not. NPRIs were placed in the cisterns of thick clots where vasospasm was highly probable. RESULTS: Four (6%) of the 69 patients treated with NPRIs and 3 (11%) of the 28 patients not treated with NPRIs developed delayed ischemic neurological deficits (DINDs). Of these patients, clinical deterioration with infarction occurred in two patients (3%). Current smoking (P = 0.0088) and intraventricular hemorrhage on admission computed tomographic (CT) scans (P = 0.0077) were correlated with DIND. CT groupings on admission and postoperatively were not correlated, nor were World Federation of Neurosurgical Societies grades. Hypertension was inversely correlated with DIND (P = 0.0233). Eighty-six patients (89%) had an independent status at 3 months. Logistic regression analysis demonstrated that age (odds ratio [OR], 6.836; P = 0.034), World Federation of Neurosurgical Societies grade (OR, 23.317; P = 0.001), intraventricular hemorrhage on admission CT scans (OR, 6.332; P = 0.024), and surgical complications (OR, 32.861; P = 0.003) were independent risk factors influencing an unfavorable outcome. CT grouping on admission and DIND were not. CONCLUSION: Our findings suggest that the incidence of DIND may decrease and, therefore, an unfavorable outcome may improve if NPRIs are applied for patients with thick clots (Fisher Group 3) during surgery.
Authors: Jasper H van Lieshout; Maxine Dibué-Adjei; Jan F Cornelius; Philipp J Slotty; Toni Schneider; Tanja Restin; Hieronymus D Boogaarts; Hans-Jakob Steiger; Athanasios K Petridis; Marcel A Kamp Journal: Neurosurg Rev Date: 2017-02-18 Impact factor: 3.042
Authors: Ryszard M Pluta; Jacob Hansen-Schwartz; Jens Dreier; Peter Vajkoczy; R Loch Macdonald; Shigeru Nishizawa; Hideotoshi Kasuya; George Wellman; Emanuela Keller; Alois Zauner; Nicholas Dorsch; Joseph Clark; Shigeki Ono; Talat Kiris; Peter Leroux; John H Zhang Journal: Neurol Res Date: 2009-03 Impact factor: 2.448
Authors: Daniel Hänggi; Nima Etminan; Hans Jakob Steiger; Mark Johnson; M Melissa Peet; Tom Tice; Kevin Burton; Bruce Hudson; Michele Turner; Angela Stella; Parissa Heshmati; Cara Davis; Herbert J Faleck; R Loch Macdonald Journal: Neurotherapeutics Date: 2016-04 Impact factor: 7.620
Authors: Daniel Hänggi; Nima Etminan; Stephan A Mayer; E Francois Aldrich; Michael N Diringer; Erich Schmutzhard; Herbert J Faleck; David Ng; Benjamin R Saville; R Loch Macdonald Journal: Neurocrit Care Date: 2019-02 Impact factor: 3.210