Nicardipine prolonged-release pellets (NP) are made for implantation during surgery to prevent cerebral vasospasm. We retrospectively analyzed patients with a poor-grade subarachnoid hemorrhage (SAH) between October 1999 and September 2004. Among 125 surgically treated SAH patients, 34 belonged to WFNS grades 4 and 5 (male/female 13/21, the average age was 63, the ratio craniotomy/coil 26/8). Four to 12 NPs (16-48 mg of nicardipine) were placed along the respective artery (IC, A1, A2, A3, M1, M2, and M3) after clipping the aneurysm, where there was thick clot and therefore subsequent vasospasm was highly likely.
The intracranial pressure was monitored and treated with glycerin, ventricular drainage, external decompression, and/or barbiturate administration. Neither induced hypervolemia nor induced hypertension was used. A delayed ischemic neurological deficit was seen in 1 patient, but there were no cerebral infarctions due to cerebral vasospasm. Angiography performed on days 7-12 revealed no vasospasm in any arteries close to where the NPs were placed. The outcome after 3 months was good in 7, moderately disabled in 13, severely disabled in 7, vegetative state in 2, and 5 patients had deceased.
The NP is an effective, simple, and safe prophylactic treatment to prevent vasospasm when a surgical procedure is chosen to treat ruptured aneurysms of poor-grade SAH patients.