Review Article

Cerebral Vasospasm Pharmacological Treatment: An Update

Table 5

Summary of clinical data regarding nicardipine prolonged release implants (NPRIs) in the management of cerebral vasospasm.

Authors/Year of PublicationType of studyNumber of patientsResults

Kasuya et al. (2005) [102]Prospective study97 patients among 125 surgically clipped patientsFour (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%). Eighty-six patients (89%) had an independent status at three months.

Barth et al. (2007) [103]Prospective study32 patientsThe incidence of angiographic vasospasm in proximal vessel segments was significantly reduced after implantation of NPRIs (73% in the control group versus 7% in the NPRIs group). CT scans revealed a lower incidence of delayed ischemic lesions (47% in the control versus 14% in the NPRIs group). The NPRI group demonstrated more favourable modified Rankin and National Institute of Health Stroke scales scores, as well as a significantly lower incidence of deaths (38% in the control versus 6% in the NPRIs group).

Krischek et al. (2007) [104]Prospective study100 patientsOnly seven patients developed DIND and five patients suffered cerebral infarction. Angiography performed on days 7–12 revealed no vasospasm in any of the arteries close to the site of NPRI placement. NPRI placement can completely prevent vasospasm.

Barth et al. (2009) [105]Retrospective study18 patientsFunctional outcome improvement is associated with NPRIs. Also administration of NPRIs resulted into: lower incidence of cerebral vasospasm, decreased incidence of new infarcts, and lower morbidity.

Schneider et al. (2011) [106]Prospective controlled study81 patientsThe incidence of vasospasm was 48%, 44% and 11% for patients after endovascular treatment, microsurgical clipping without NPRIs, and microsurgical clipping with NPRIs, respectively. New cerebral infarctions occurred in 28%, 22% and 7% of their groups, respectively. A good clinical recovery 1 year after was seen in 48%, 50% and 77% of their patients, respectively.

Thomé et al. (2011) [107]Review studyUnknownSeveral clinical protocols revealed that NPRIs dramatically reduce the incidence and severity of angiographic vasospasm. They found that NPRIs resulted into reduction of cerebral infarctions, and delayed ischemic neurologic deficits. On average, the incidence of angiographic vasospasm decreased from approximately 70% to less than 10%. Efficacy seemed to be dose-dependent.

Barth et al. (2011) [108]Prospective study31 patientsA significant positive angiographic effect caused by NPRIs could only be observed in surgically clipped patients.

Kasuya (2013) [109]Prospective studyUnknownVasospasm was completely prevented in cerebral arteries by placing NPRIs adjacent to them intraoperatively. No complications were reported.