This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kasuya, H. Articles by Hori, T. Search for Related Content PubMed PubMed Citation Articles by Kasuya, H. Articles by Hori, T. Related Collections Cerebrovascular disease/stroke Other Treatment Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage Angiography Primary and Secondary Stroke Prevention

(Stroke. 2002;33:1011.)
© 2002 American Heart Association, Inc.

Original Contributions

Efficacy and Safety of Nicardipine Prolonged-Release Implants for Preventing Vasospasm in Humans

Hidetoshi Kasuya, MD; Hideaki Onda, MD; Mikihiko Takeshita, MD; Yoshikazu Okada, MD Tomokastu Hori, MD

From the Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan.

Correspondence to Hidetoshi Kasuya, MD, Department of Neurosurgery, Tokyo Women’s Medical University, Kawada-cho 8 to 1, Shinjuku-ku, Tokyo 162, Japan 162-8666. E-mail hkasuya{at}nij.twmu.ac.jp

Background and Purpose— Despite extensive investigative efforts, there are few treatments that can prevent vasospasm after subarachnoid hemorrhage. This study was conducted to examine the efficacy and safety of nicardipine prolonged-release implants (NPRI) for humans, which have already been proven in dogs.

Methods— Twenty consecutive subarachnoid hemorrhage patients with thick subarachnoid clot were treated with NPRI (a pellet of diameter 2 mm, length 10 mm, containing 4 mg of nicardipine) during surgery after clipping of their aneurysm. The number and location of pellets depended on the amount and site of subarachnoid clot on preoperative CT and on craniotomy.

Results— Two to 10 pellets were implanted in the cistern of the internal carotid, middle cerebral, and/or anterior cerebral artery, where thick clots existed and therefore vasospasm related to delayed ischemic neurological deficits was highly likely. Delayed ischemic neurological deficits and cerebral infarctions were seen in 1 patient. Angiography performed on days 7 to 12 revealed no vasospasm in any arteries near which NPRI were placed. No complications were experienced.

Conclusions— Vasospasm was completely prevented for the arteries in thick clot cisterns, when NPRI were placed adjacent to the arteries during surgery. This drug-delivery system offers a promising approach for preventing vasospasm.

Key Words: copoly(lactic/glycolic acid) • drug delivery systems • nicardipine • subarachnoid hemorrhage • vasospasm, intracranial

This article has been cited by other articles:

				J.G. Tejada, R.A. Taylor, M.S. Ugurel, M. Hayakawa, S.K. Lee, and J.C. Chaloupka Safety and Feasibility of Intra-Arterial Nicardipine for the Treatment of Subarachnoid Hemorrhage-Associated Vasospasm: Initial Clinical Experience with High-Dose Infusions AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 844 - 848. [Abstract] [Full Text] [PDF]

				M. Barth, H.-H. Capelle, S. Weidauer, C. Weiss, E. Munch, C. Thome, T. Luecke, P. Schmiedek, H. Kasuya, and P. Vajkoczy Effect of Nicardipine Prolonged-Release Implants on Cerebral Vasospasm and Clinical Outcome After Severe Aneurysmal Subarachnoid Hemorrhage: A Prospective, Randomized, Double-Blind Phase IIa Study Stroke, February 1, 2007; 38(2): 330 - 336. [Abstract] [Full Text] [PDF]

				N. Badjatia, M. A. Topcuoglu, J. C. Pryor, J. D. Rabinov, C. S. Ogilvy, B. S. Carter, and G. A. Rordorf Preliminary Experience with Intra-Arterial Nicardipine as a Treatment for Cerebral Vasospasm AJNR Am. J. Neuroradiol., May 1, 2004; 25(5): 819 - 826. [Abstract] [Full Text] [PDF]

				R. L. Macdonald Advances in Vascular Surgery Stroke, February 1, 2004; 35(2): 375 - 380. [Full Text] [PDF]

				H. Kasuya, H. Onda, T. Yoneyama, T. Sasaki, and T. Hori Bedside Monitoring of Circulating Blood Volume After Subarachnoid Hemorrhage Stroke, April 1, 2003; 34(4): 956 - 960. [Abstract] [Full Text] [PDF]