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The use of nicardipine prolonged release implants (NPRI) in microsurgical clipping after aneurysmal subarachnoid haemorrhage: comparison with endovascular treatment

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Abstract

Background

Nicardipine prolonged release implants (NPRI) have been shown to decrease the incidence of cerebral vasospasm and infarcts significantly in patients after aneurysmal subarachnoid haemorrhage (SAH) following microsurgical clipping. Yet, the comparison with results after endovascular coiling is lacking. This study was conducted to determine the differences in the incidence of cerebral vasospasm and infarctions between those two treatment modalities

Methods

The design of this investigation reflects a case-control study; 27 patients suffering from acute SAH were treated by microsurgical clipping and received an intracisternal implantation of NPRI. Twenty-seven matching consecutive patients after microsurgical treatment without implantation of NPRI or endovascular treatment, respectively, served as controls. The incidence of angiographic vasospasm and cerebral infarctions were documented.

Results

All groups were comparable concerning demographics and severity of SAH. Twenty-four of 81 patients developed angiographic vasospasm (>33% constriction). The incidence of vasospasm was 48%, 44% and 11% for patients after endovascular treatment, microsurgical clipping without NPRI and microsurgical clipping with NPRI, respectively. New cerebral infarctions occurred in 28%, 22% and 7% of the treated patients, respectively. A good clinical recovery 1 year after the initial bleeding (modified Rankin scale 0–2) was seen in 48%, 50% and 77% of the treated patients, respectively.

Conclusion

The use of NPRI during microsurgical clipping was confirmed to be safe and effective. Patients who received intracisternally implanted NPRI during clipping after aneurysmal SAH yielded significantly lower vasospasm and infarction rates, and showed a better clinical outcome when compared with clipping without NPRI and also when compared with endovascular coiling.

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Acknowledgements

We thank our colleagues in the Neurological ICU for their unstinting support.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Ulf C. Schneider, Stefanie Dreher & Peter Vajkoczy

  2. Department of Neuroradiology, University Clinic Leipzig, Leipzig, Germany

    Karl-Titus Hoffmann

  3. Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Peter Schmiedek

  4. Department of Neurosurgery, Medical Center East, Tokyo Women’s Medical University, Tokyo, Japan

    Hidetoshi Kasuya

  5. Center for Stroke Research, Charité Universitätsmedizin, Berlin, Germany

    Peter Vajkoczy

Authors
  1. Ulf C. Schneider
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  2. Stefanie Dreher
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  3. Karl-Titus Hoffmann
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  4. Peter Schmiedek
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  5. Hidetoshi Kasuya
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  6. Peter Vajkoczy
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Correspondence to Peter Vajkoczy.

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Schneider, U.C., Dreher, S., Hoffmann, KT. et al. The use of nicardipine prolonged release implants (NPRI) in microsurgical clipping after aneurysmal subarachnoid haemorrhage: comparison with endovascular treatment. Acta Neurochir 153, 2119–2125 (2011). https://doi.org/10.1007/s00701-011-1129-8

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  • DOI: https://doi.org/10.1007/s00701-011-1129-8

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