Anticipatory initiation of intrathecal nicardipine reduces delayed cerebral ischemia in subarachnoid hemorrhage: An exploratory study.
Publication/Presentation Date
4-13-2026
Abstract
OBJECTIVE: Intrathecal nicardipine (ITN) is one treatment for vasospasm in subarachnoid hemorrhage (SAH), however, its efficacy is unclear. We sought to evaluate outcomes when ITN is utilized.
METHODS: We performed retrospective chart review of all patients with aSAH requiring placement of an extra-ventricular drain at our institution from 2013 to 2023. We identified patients who received ITN (cases). Patients who received EVDs but no intrathecal nicardipine served as controls. We collected admission Hunt-Hess (HH) and Modified Fisher (mF), and trans-cranial doppler Lindegaard ratios. Delayed cerebral ischemia (DCI) was defined as the onset of infarcts on imaging or acute focal neurologic deficits (≥1 h) consistent with vasospasm. The circumstances in which ITN was initiated was defined as reactionary if it followed the onset of DCI and anticipatory otherwise. The incidence of DCI infarcts on imaging was our primary outcome.
RESULTS: We identified 44 cases and 87 controls. Controls had higher mF (median=4) than cases (median=3, p = 0.038), but there was no significant difference in HH (p = 0.16). Overall, there was no difference in the incidence of DCI infarct between cases and controls (56.2% versus 55.2%, p = 0.86), yet cases were less likely to attain functional independence than controls (31.8% versus 54%, p = 0.016). Of the 44 cases, 16 received anticipatory ITN. Controls and anticipatory cases had no difference in mF and a trend toward increased HH among anticipatory cases. Anticipatory cases were significantly less likely to develop DCI infarct than controls (31.3% versus 55.2%, p = 0.042). Controls and anticipatory cases had similar incidences of 90-day mRS≤ 2 (54% and 38%, p = 0.13).
CONCLUSION: Anticipatory ITN was associated with reduced rates of parenchymal infarcts and recalcitrant vasospasm. Among patients already experiencing DCI, reactionary ITN was not associated with reduced rates of additional infarcts or recalcitrant vasospasm. This offers rationale for further study of earlier initiation of ITN among SAH patients at high risk of DCI.
Volume
267
First Page
109433
Last Page
109433
ISSN
1872-6968
Published In/Presented At
Cotroneo, M. J., Akkipeddi, S. M. K., Kohli, G. S., Ellens, N. R., Barrera, P. V., McHugh, D. C., George, B. P., Roberts, D. E., Nguyen, V. N., Mattingly, T. K., Bhalla, T., & Bender, M. T. (2026). Anticipatory initiation of intrathecal nicardipine reduces delayed cerebral ischemia in subarachnoid hemorrhage: An exploratory study. Clinical neurology and neurosurgery, 267, 109433. Advance online publication. https://doi.org/10.1016/j.clineuro.2026.109433
Disciplines
Medicine and Health Sciences
PubMedID
42054968
Department(s)
Department of Surgery
Document Type
Article