Efficacy of Continuous Nicardipine Infusion for Preventing Vasospasm after Subarachnoid Hemorrhage

Nicardipine, a calcium channel blocker, is a peripheral vasodilator agent. It may play a potential role in preventing cerebral vasospasm after subarachnoid hemorrhage (SAH). We evaluated the effect of nicardipine in preventing cerebral vasospasm following SAH in 256 patients treated with surgical clipping between 2006 and 2014. The patients were classified into two groups: Group A (controls, 191 patients) and Group B (nicardipine, mean dose: 0.58 μg/body weight/min: γ, 1.98 mg/h; 65 patients who received their respective treatments from postoperative day 1 to 14). The incidence of symptomatic vasospasm and new cerebral infarction due to vasospasm as observed on magnetic resonance imaging (MRI) and the need for interventional neuroendovascular therapy were significantly lower in the nicardipine-treated group than the control group. The incidences of symptomatic vasospasm cases were 21.5% (Group A) and 3.1% (Group B), the incidences of new cerebral infarction due to vasospasm were 19.4% (Group A) and 4.6% (Group B), and the incidences of the need for interventional neuroendovascular therapy were 12% (Group A) and 1.5% (Group B). Our results suggest that continuous intravenous infusion of low dose nicardipine, in combination with fasudil hydrochloride, prevents cerebral vasospasm after SAH.