BACKGROUND AND PURPOSE: The purpose of this study was to investigate the effect of nicardipine prolonged-release implants (NPRIs) on cerebral vasospasm and clinical outcome after severe subarachnoid hemorrhage. METHODS:Thirty-two patients with severe subarachnoid hemorrhage and undergoing aneurysm clipping were included into this single center, randomized, double-blind trial. Sixteen patients receivedNPRIs implanted into the basal cisterns in direct contact to the exposed proximal blood vessels; in 16 control patients, the basal cisterns were opened and washed out only without leaving implants. Angiography was performed preoperatively and at day 8+/-1. Computed tomography imaging was analyzed for the incidence of territorial infarcts unrelated to surgery. Patient outcome was assessed using the modified Rankin and National Institute of Health Stroke scales. RESULTS: The incidence of angiographic vasospasm in proximal vessel segments was significantly reduced after implantation of NPRIs (73% control versus 7% NPRIs). Significant differences occurred also for the majority of distal vessel segments. Computed tomography scans revealed a lower incidence of delayed ischemic lesions (47% control versus 14% NPRIs). The NPRI group demonstrated more favorable modified Rankin and National Institute of Health Stroke scales as well as a significantly lower incidence of deaths (38% control versus 6% NPRIs). CONCLUSIONS: Implantation of NPRIs reduces the incidence of cerebral vasospasm and delayed ischemic deficits and improves clinical outcome after severe subarachnoid hemorrhage.
RCT Entities:
BACKGROUND AND PURPOSE: The purpose of this study was to investigate the effect of nicardipine prolonged-release implants (NPRIs) on cerebral vasospasm and clinical outcome after severe subarachnoid hemorrhage. METHODS: Thirty-two patients with severe subarachnoid hemorrhage and undergoing aneurysm clipping were included into this single center, randomized, double-blind trial. Sixteen patients received NPRIs implanted into the basal cisterns in direct contact to the exposed proximal blood vessels; in 16 control patients, the basal cisterns were opened and washed out only without leaving implants. Angiography was performed preoperatively and at day 8+/-1. Computed tomography imaging was analyzed for the incidence of territorial infarcts unrelated to surgery. Patient outcome was assessed using the modified Rankin and National Institute of Health Stroke scales. RESULTS: The incidence of angiographic vasospasm in proximal vessel segments was significantly reduced after implantation of NPRIs (73% control versus 7% NPRIs). Significant differences occurred also for the majority of distal vessel segments. Computed tomography scans revealed a lower incidence of delayed ischemic lesions (47% control versus 14% NPRIs). The NPRI group demonstrated more favorable modified Rankin and National Institute of Health Stroke scales as well as a significantly lower incidence of deaths (38% control versus 6% NPRIs). CONCLUSIONS: Implantation of NPRIs reduces the incidence of cerebral vasospasm and delayed ischemic deficits and improves clinical outcome after severe subarachnoid hemorrhage.
Authors: Na Lu; Daniel Jackson; Sothear Luke; Emir Festic; Ricardo A Hanel; William David Freeman Journal: Neurocrit Care Date: 2012-06 Impact factor: 3.210
Authors: Johannes Woitzik; Jens P Dreier; Nils Hecht; Ingo Fiss; Nora Sandow; Sebastian Major; Maren Winkler; Yuliya A Dahlem; Jerome Manville; Michael Diepers; Elke Muench; Hidetoshi Kasuya; Peter Schmiedek; Peter Vajkoczy Journal: J Cereb Blood Flow Metab Date: 2011-12-07 Impact factor: 6.200
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: Jens P Dreier; Sebastian Major; Andrew Manning; Johannes Woitzik; Chistoph Drenckhahn; Jens Steinbrink; Christos Tolias; Ana I Oliveira-Ferreira; Martin Fabricius; Jed A Hartings; Peter Vajkoczy; Martin Lauritzen; Ulrich Dirnagl; Georg Bohner; Anthony J Strong Journal: Brain Date: 2009-05-06 Impact factor: 13.501