Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm

Department of Interventional Neuroradiology and Endovascular Neurosurgery, Massachusetts General Hospital, 55 Fruit St, GRB-2-241, Boston, MA 02114, USA.
American Journal of Neuroradiology (Impact Factor: 3.59). 11/2008; 30(1):160-4. DOI: 10.3174/ajnr.A1275
Source: PubMed


Our aim was to determine the effects of intra-arterial (IA) nicardipine infusion on the cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH)-induced vasospasm by using first-pass quantitative cine CT perfusion (CTP).
Six patients post-aSAH with clinical and transcranial Doppler findings suggestive of vasospasm were evaluated by CT angiography and CTP immediately before angiography for possible vasospasm treatment. CTP was repeated immediately following IA nicardipine infusion. Maps of mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were constructed and analyzed in a blinded manner. Corresponding regions of interest on these maps from the bilateral middle cerebral artery territories and, when appropriate, the bilateral anterior or posterior cerebral artery territories, were selected from the pre- and posttreatment scans. Normalized values were compared by repeated measures analysis of variance.
Angiographic vasospasm was confirmed in all patients. In 5 of the 6 patients, both CBF and MTT improved significantly in affected regions in response to nicardipine therapy (mean increase in CBF, 41 +/- 43%; range, -9%-162%, P = .0004; mean decrease in MTT, 26 +/- 24%; range, 0%-70%, P = .0002). In 1 patient, we were unable to quantify improvement in flow parameters due to section-selection differences between the pre- and posttreatment examinations.
IA nicardipine improves CBF and MTT in ischemic regions in patients with aSAH-induced vasospasm. Our data provide a tissue-level complement to the favorable effects of IA nicardipine reported on prior angiographic studies. CTP may provide a surrogate marker for monitoring the success of treatment strategies in patients with aSAH-induced vasospasm.

Full-text preview

Available from:
  • Source
    • "In this study, this prerequisite was not met. Nicardipine may have direct effects on the cerebral vasculature, as it led to vascular remodeling and cerebral vasodilatation in pial and intracerebral arteries in a rat model, and reduced cerebral vasospasm in patients with subarachnoid hemorrhage (Sabbatini et al, 2001; Nogueira et al, 2009). Thus, it is possible that the observed stability in CBF in response to reduced blood pressure was due at least partially to cerebral vasodilatation that was mediated directly by nicardipine. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cerebral autoregulation aims to stabilize blood flow to the brain during variations in perfusion pressure, thus protecting the brain against the risks of low or high systemic blood pressure. This vital mechanism is severely impaired in the transgenic mouse model of Alzheimer's disease (AD) that abundantly produces amyloid-β peptide β(1-42). These observations have been extrapolated to human AD, wherein impairment of autoregulation could have important implications for the clinical management and prevention of AD. Research on cerebral autoregulation in human AD, however, has only recently become available. Contrary to the animal models, preliminary studies suggest that cerebral autoregulation is preserved in patients with AD. Further research is urgently needed to elucidate this discrepancy in the current literature, given the accumulating evidence that implicates cerebrovascular pathology in AD.
    Full-text · Article · May 2011 · Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism
  • [Show abstract] [Hide abstract]
    ABSTRACT: The inclusion of dynamic contrast-enhanced computed tomography (CT) or CT perfusion (CTP) scan into the imaging workup for acute stroke patients is widespread. Along with vessel occlusion status from CT angiography, CTP provides pathophysiological information a non-contrast CT cannot provide during the hyperacute stages of cerebral ischemia. Measurement of parenchymal perfusion at the capillary level can be used to characterize tissue viability, a target for thrombolysis. Further, CTP is useful for the detection of blood brain barrier disturbances with the permeability surface area product parameter (PS). Although new to stroke imaging, PS has diagnostic and prognostic implications for primary hemorrhage and secondary hemorrhagic transformation of ischemic stroke. The purpose of this article is to provide an overview of the CTP imaging concepts and their uses for imaging in stroke.
    No preview · Article · Jun 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In a rapidly advancing specialty, it is essential to review the recent studies of alternative new treatments and present their efficacy, safety and outcome. We discuss the recent advances in the endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage in the past few years with special focus on the literature regarding this subject in the last 18-24 months. The recent findings are as follows: effect of papaverine on brain oxygen; recent evaluation concerning nimodipine use; combined intraarterial and intravenous use of milrinone; illustration of the numerous recent studies on nicardipine; the safety and efficacy of high-dose intraarterial verapamil; outcome and adverse effects of intraarterial fasudil; transluminal balloon angioplasty; and recent evaluation of its efficacy and evaluation of its prophylactic use. Endovascular treatment, including intraarterial vasodilators and transluminal balloon angioplasty, has a very important place in the management of symptomatic vasospasm related to aneurysmal subarachnoid hemorrhage. The efficacy of intraarterial vasodilators has been proven. Numerous studies and analysis of different treatments of cerebrovascular vasospasm took place in the past period. This allowed more understanding and evaluation of their outcome, safety and efficacy helping physicians to choose better treatments to adopt. It emphasizes also the aspects that need more study and research.
    Full-text · Article · Jan 2010 · Current Opinion in Critical Care
Show more