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*For medical professionals only, intrathecal
nicardipine is effective and safe
for the treatment of cerebral vasospasm associated with aneurysmal subarachnoid hemorrhage.
that primarily affects adults aged 40 to 60 years.
In clinical practice, patients often have small, medium and large vasospasm at the same time after aSAH, which leads to serious complications such as delayed cerebral ischemia and stroke, which limits the treatment options of aSAH and puts forward high requirements
for its treatment drugs.
First of all, can you talk about how clinicians choose treatment drugs when facing aSAH patients?
Q2 Past studies have found that intrathecal nicardipine improves symptomatic vasospasm and reduces mean cerebral blood flow velocity, improving prognosis
.
The study concluded that intrathecal nicardipine was effective and safe
for the treatment and prevention of aSAH-associated cerebral vasospasm.
In this regard, can you talk about how you see the efficacy of nicardipine in aSAH-related cerebral vasospasm?
in related disease areas.
If copyright issues are involved, please contact us and we will deal with it
as soon as possible.
For information purposes only by healthcare professionals
.
Such information is not in any way a substitute for professional medical advice and should not be considered as medical advice
.
If such information is used for purposes other than understanding information, this site and the author do not assume relevant responsibility
.
nicardipine is effective and safe
for the treatment of cerebral vasospasm associated with aneurysmal subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) refers to the rupture of blood vessels at the base of the brain or the surface of the brain caused by various reasons, and the hemorrhage enters the subarachnoid space, that is, between the arachnoid membrane and the pia mater, which can be divided into traumatic and spontaneous, of which 85% of spontaneous subarachnoid hemorrhage is related to intracranial aneurysm rupture [1].
Aneurysmal subarachnoid hemorrhage (aSAH) causes frequent contraction or damaged vascular morphological changes in skull base artery smooth muscle, which is prone to secondary cerebral vasospasm, which in turn leads to delayed cerebral ischemia (DCI) or cerebral infarction [2].
Therefore, giving active and effective measures to patients with aSAH to prevent cerebral vasospasm is of great
significance to improve the prognosis of patients.
3H therapy, which includes hypertension, hypervolemia and hemodilution, has been recognized in the past as an effective treatment
against cerebral vasospasm and improve cerebral vascular perfusion.
However, in clinical practice, some patients still show severe cerebral vasospasm after treatment due to serious comorbidities and other factors, which leads to certain limitations in the clinical application of traditional treatment options.
Targeted therapy with calcium channel blockers (CCBs) is considered the best treatment for macrovasospasm, and nicardipine acts as a dihydropyridine CCB that exerts vasodilating effects
by inhibitingCa2+ influx into vascular smooth muscle cells.
A series of past studies [3-5] have demonstrated that nicardipine can improve symptomatic cerebral vasospasm and severe vasospasm, reduce mean blood flow velocity, and improve patient outcomes
.
However, in order to maximize the efficacy of vasoactive drugs and minimize their side effects, clinically it is necessary to consider the use of therapeutic drugs, which also include nicardipine
.
A systematic review analysis [6] screened a total of 825 articles, and after removing duplicate literature and normative selection criteria, nine articles met the inclusion and analysis criteria
.
A total of 377 patients in the study received 6596 injections of intrathecaladipine for aSAH-associated cerebral vasospasm
.
The included literature involved a variety of dosing regimens and preparations for intrathecal nicardipine, with studies using 4 mg nicardipine diluted 10 mL of 0.
9% saline and drained
through brain cisterns.
There have also been studies using the same dose of nicardipine but diluted with only 2 mL of 0.
9% normal saline to reduce the volume
of fluid injected intrathecally.
In other studies, the dose and frequency were mostly nicardipine every 6 to 12 hours/2 to 4 mg, with the most common reported regimen being 4 mg
every 12 hours.
Studies of snicardipine in the treatment of aSAH have assessed cerebral blood flow through many different methods, but this systematic review will focus on the two most common: transcranial Doppler (TCD) mean blood flow velocity and angiography cerebral vasospasm
.
In the nine studies included in this systematic retrospective analysis, intrathecal nicardipine
was initiated when TCD-measured middle cerebral artery (MCA) blood flow velocities of more than 120 cm/s, regardless of whether the patient had clinical deterioration.
In a study to evaluate the average blood flow velocity of TCD, it was found that the MCA of patients decreased significantly after intrathecal nicardipine, from 120 cm/s to 82 cm/s, 43.
1 cm/s within 8 hours, and from 155 cm/s to 129 cm/s
, respectively.
In a study evaluating the rate of angiographic vasospasm, the literature found a 26% reduction in symptomatic vasospasm and a 20%
reduction in angiographic vasospasm in 50 patients with preventive therapy.
It was also noted that compared with the control group, 21 patients who received intrathecal nicardipine twice a day for 10 days had a 22% reduction in the incidence of severe vasospasm (7% vs.
29%)
.
In addition, the cumulative infection rate in nine studies was 6%, similar to the rate of ventriculostomy-related infection (8.
8%), and there was no significant increase in infection rate
.
Through this retrospective systematic analysis, it can be seen that aSAH received intrathecalicardipine treatment, and the transcranial Doppler measurement of angiographic vasospasm and symptomatic vasospasm were significantly reduced, and the average cerebral blood flow velocity decreased
.
This suggests that intrathecal nicardipine is effective and safe
for the treatment and prevention of aSAH-associated cerebral vasospasm.
As a dihydropyridine CCB, nicardipine can inhibit the voltage-dependent calcium channel of vascular smooth muscle, reduceCa2+ influx, thereby causing vasodilation and improving cerebral blood flow, and intrathecal injection of nicardipine can be considered clinically to treat aSAH, ultimately improving patient prognosis
.
that primarily affects adults aged 40 to 60 years.
In clinical practice, patients often have small, medium and large vasospasm at the same time after aSAH, which leads to serious complications such as delayed cerebral ischemia and stroke, which limits the treatment options of aSAH and puts forward high requirements
for its treatment drugs.
First of all, can you talk about how clinicians choose treatment drugs when facing aSAH patients?
■Improve cerebral vasospasm, control blood pressure, preferably nicardipine
Li Haigang, First Affiliated Hospital of the Chinese People's Liberation Army Air Force Military Medical University
aSAH is a common cerebrovascular disease in clinical neurosurgery, and cerebral vasospasm is one of the most serious complications of clinical subarachnoid hemorrhage, and it is also an important cause of disability and death in patients with subarachnoid hemorrhage, which poses a serious threat
to the life and safety of patients.
Clinically, traditional conventional methods are used to stop bleeding, sedation and dehydration to reduce intracranial pressure for subarachnoid hemorrhage, but conventional treatment can easily cause serious complications
such as cerebral ischemia and cerebral infarction.
Nicardipine, as a dihydropyridine CCB, can effectively improve the symptoms of cerebral ischemia and prevent vasospasm
.
Long-term clinical practice has found that patients with cerebral vasospasm after subarachnoid hemorrhage are treated with nicardipine on the basis of conventional treatment, and the clinical effect is more obvious than that of conventional basic treatment and cerebral vasospasm is significantly improved
.
In addition, nicardipine can effectively and reasonably control blood pressure, so that the risk of secondary bleeding is significantly reduced compared with conventional treatment, and the prognosis
of patients is greatly improved.
Q2 Past studies have found that intrathecal nicardipine improves symptomatic vasospasm and reduces mean cerebral blood flow velocity, improving prognosis
.
The study concluded that intrathecal nicardipine was effective and safe
for the treatment and prevention of aSAH-associated cerebral vasospasm.
In this regard, can you talk about how you see the efficacy of nicardipine in aSAH-related cerebral vasospasm?
■Intrathecal injection of nicardipine can effectively reduce vasospasm
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Yao Yi
Aneurysmal subarachnoid hemorrhage is a common neurological emergency, and patients often have congenital malformed blood vessels, but more patients have hypertension foundation, and patients with poor blood pressure control are usually high-risk groups
.
In the event of subarachnoid hemorrhage, in addition to surgical treatment, patients who do not undergo surgery before or partially do not undergo surgery require conservative medical treatment, and blood pressure control is a critical part
of conservative management.
Nicardipine, as the current clinically preferred intravenous antihypertensive drug, has the advantage that it can not only quickly reach the target blood pressure, but also effectively improve cerebral vasospasm and reduce cerebral blood flow velocity
when injecting nicardipine intrathecally.
Nicardipine is commonly used in interventional surgery to control blood pressure, and compared with patients who do not use nicardipine, it has been clinically found that patients using nicardipine have significantly reduced the incidence of intraoperative vasospasm, which has helped
the stability of surgery.
■Antihypertensive does not forget to ensure the perfusion of organ blood flow, and nicardipine has obvious advantages in the treatment of subarachnoid hemorrhage
Fan Zheng, Pingjiang New Hospital, The First Affiliated Hospital of Soochow University
Nicardipine hydrochloride acts on vascular smooth muscle and has a highly specific antihypertensive effect
.
Its main advantage is that it can reduce pressure quickly, smoothly and controllably, while also ensuring the perfusion
of important organs.
Nicardipine is considered to be suitable for almost all hypertensive emergencies and is the first-line treatment
for hypertensive emergencies.
Domestic and foreign guidelines such as "Chinese Hypertension Emergency Diagnosis and Treatment Standards 2020" and "International Society of Hypertension (ISH) Global Practice Guidelines for Hypertension" unanimously recommend that nicardipine can be used as a first-line antihypertensive drug
for patients with hypertensive emergencies such as ischemic stroke, cerebral hemorrhage, subarachnoid hemorrhage, hypertensive encephalopathy, and aortic dissection.
Analyzing its mechanism, nicardipine can relax blood vessels by blocking peripheral arterial vascular smooth muscle cells and inhibitingCa2+ influx (more suitable for the pathophysiology of hypertensive emergencies).
In terms of antihypertensive, nicardipine has a rapid onset of action, stable blood pressure reduction, small blood pressure variability, sustained efficacy, can well control the rhythm and amplitude of blood pressure, high controllability, and is worthy of clinical optimization in the treatment of hypertensive emergencies
.
References:
[1] Guidelines for the diagnosis and treatment of subarachnoid hemorrhage in China 2019[J].
Chinese Journal of Neurology,2019,12:1006-1007-1008-1009-1010-1011-1012-1013-1014-1015-1016-1017-1018-1019-1020-1021.
[2] Cao Hui.
Correlation between human serum EPO content and cerebral vasospasm caused by spontaneous subarachnoid hemorrhage[D].
Sichuan Medical University,2015.
[3] Ehtisham A, Taylor S, Bayless L, Samuels OB, Klein MW, Janzen JM.
Use of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm.
South Med J.
2009; 102(2):150–153
[4] Goodson K, Lapointe M, Monroe T, Chalela JA.
Intraventricular nicardipine for refractory cerebral vasospasm after subarachnoid hemorrhage.
Neurocrit Care.
2008; 8(2):247–252.
[5] Ko SB, Choi HA, Helbok R, et al.
Acute effects of intraventricular nicardipine on cerebral hemodynamics: a preliminary finding.
Clin Neurol Neurosurg.
2016; 144:48–52.
[6] Hafeez S, Grandhi R.
Systematic Review of Intrathecal Nicardipine for the Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage.
Neurocrit Care.
2019 Oct; 31(2):399-405.
in related disease areas.
If copyright issues are involved, please contact us and we will deal with it
as soon as possible.
For information purposes only by healthcare professionals
.
Such information is not in any way a substitute for professional medical advice and should not be considered as medical advice
.
If such information is used for purposes other than understanding information, this site and the author do not assume relevant responsibility
.
