1130. Intrathecal Nicardipine for Aneurysmal Subarachnoid Hemorrhage Induced Vasospasm

Award: Second Place Cerebrovascular Eposter Award

Authors: Jonathan M. Parish, MD; Robert Ziechmann, MD; Natalie Guley, MD, PhD; Scott Wait, MD; Joe Bernard, MD (Charlotte, NC)

Introduction: Cerebral vasospasm is a common complication of aneurysmal subarachnoid hemorrhage and is associated with significant morbidity and mortality. We report our experience with intraventricular nicardipine for treatment of moderate to severe vasospasm. Methods: A retrospective, single institution study was performed for all patients treated with intrathecal nicardipine from October 2014-May 2017. The primary goal was to evaluate the safety of intrathecal nicardipine to treat subarachnoid induced cerebral vasospasm and reduce the rate of balloon angioplasty. Results: A total of 48 patients with aneurysmal subarachnoid hemorrhage were treated with intrathecal nicardipine for moderate or severe vasospasm as determined by CTA (43/48) or transcranial dopplers greater than 140 cm/sec (5/48). The average age was 49.6 years (range 14 – 77 years) with mean Hunt-Hess of 3.2 and mean Fisher scores of 3.1. Patients were treated with dosing regiments ranging from 2mg q12 to 4mg q8hr with an average total dose of 35.1 mg (range 6 to 112 mg). The average initiation of treatment was post bleed day 6 (range day 2-15) and length of treatment was 5.9 days (range 1-15 days). Only 8/48 (16.7%) patients underwent balloon angioplasty and 3 of those (6.3%) occurred after the initiation of intrathecal nicardipine. Three patients (6.3%) developed meningitis or ventriculitis with two of those patients receiving three times a day dosing for greater than 7 days. One patient developed seizure after initiation of treatment but did not require discontinuation of therapy. One patient developed headache requiring discontinuation of treatment. Three (6.3%) patients required ventriculoperitoneal shunt. Conclusion: The use of intrathecal nicardipine should be considered a safe option in the treatment of cerebral vasospasm. The use of intrathecal nicardipine has resulted in a near discontinuation of balloon angioplasty in our institution. Randomized trials to identify the optimal dosing, timing, and length of treatment is warranted.