Nicardipine prolonged-release implants for preventing cerebral vasospasm after subarachnoid hemorrhage: effect and outcome in the first 100 patients.

Vasospasm following subarachnoid hemorrhage (SAH) remains difficult to prevent despite extensive investigative efforts. Nicardipine prolonged-release implants (NPRIs) have been used to prevent vasospasm in patients with SAH since October 1999. The present study analyzed the efficacy and safety of NPRIs in 100 patients with SAH and thick subarachnoid clot (mainly Fisher group 3) treated with NPRIs (diameter 2 mm, length 10 mm, containing 4 mg of nicardipine) during surgery after clipping of the aneurysm. The number and location of pellets depended on the amount and site of the subarachnoid clot on preoperative computed tomography and on the type of craniotomy. Two to 12 pellets were implanted in the cisterns of the internal carotid artery, middle cerebral artery, and/or anterior cerebral artery, where thick clots were present and vasospasm related to delayed ischemic neurological deficit (DIND) was highly likely. Only seven patients developed DIND and five patients suffered cerebral infarction. Angiography performed on days 7-12 revealed no vasospasm in any of the arteries close to the site of NPRI placement. NPRI placement can completely prevent vasospasm in arteries within the cisterns containing thick clots, but is less effective in remote locations.