Nicardipine implants may improve aSAH outcomes

Placing nicardipine-release implants during microsurgical aneurysm repair helps prevent angiographic vasospasm following aneurysmal subarachnoid haemorrhage (aSAH), according to a study.

The study included 41 consecutive patients with World Federation of Neurological Surgeons grade 3 or 4 aSAH due to a ruptured anterior circulation aneurysm requiring microsurgical aneurysm repair. These patients were randomly assigned to intraoperatively receive 10 implants of nicardipine at 4 mg each plus standard of care (implant group n=21, mean age 53.6 years, 67 percent female) or aneurysm repair alone plus standard of care (control group n=20, mean age 54.9 years, 85 percent female).

The primary efficacy analysis included 39 patients. Digital subtraction angiography was used to determine the primary endpoint of the incidence of moderate-to-severe cerebral angiographic vasospasm between days 7 and 9 after aneurysm rupture.

Moderate-to-severe cerebral angiographic vasospasm occurred with significantly less frequency among patients in the implant vs the control group (20 percent vs 58 percent; p=0.02). Likewise, the need for vasospasm rescue therapy was substantially reduced in the implant group (10 percent vs 58 percent; p=0.002).

Between days 13 and 15 after aneurysm rupture, the incidence of new cerebral infarcts did not significantly differ between the implant group and the control group (10 percent vs 32 percent; p=0.13). Favourable outcomes at 52 weeks were recorded among 84 percent of patients in the implant group and among 67 percent in the control group (p=0.27).

Adverse event rates did not significantly differ between the two groups.