Frontiers in Neurology (Mar 2023)

Microvascular cerebral blood flow response to intrathecal nicardipine is associated with delayed cerebral ischemia

  • Eashani Sathialingam,
  • Kyle R. Cowdrick,
  • Amanda Y. Liew,
  • Zhou Fang,
  • Seung Yup Lee,
  • Seung Yup Lee,
  • Courtney E. McCracken,
  • Feras Akbik,
  • Owen B. Samuels,
  • Prem Kandiah,
  • Ofer Sadan,
  • Erin M. Buckley,
  • Erin M. Buckley,
  • Erin M. Buckley

DOI
https://doi.org/10.3389/fneur.2023.1052232
Journal volume & issue
Vol. 14

Abstract

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One of the common complications of non-traumatic subarachnoid hemorrhage (SAH) is delayed cerebral ischemia (DCI). Intrathecal (IT) administration of nicardipine, a calcium channel blocker (CCB), upon detection of large-artery cerebral vasospasm holds promise as a treatment that reduces the incidence of DCI. In this observational study, we prospectively employed a non-invasive optical modality called diffuse correlation spectroscopy (DCS) to quantify the acute microvascular cerebral blood flow (CBF) response to IT nicardipine (up to 90 min) in 20 patients with medium-high grade non-traumatic SAH. On average, CBF increased significantly with time post-administration. However, the CBF response was heterogeneous across subjects. A latent class mixture model was able to classify 19 out of 20 patients into two distinct classes of CBF response: patients in Class 1 (n = 6) showed no significant change in CBF, while patients in Class 2 (n = 13) showed a pronounced increase in CBF in response to nicardipine. The incidence of DCI was 5 out of 6 in Class 1 and 1 out of 13 in Class 2 (p < 0.001). These results suggest that the acute (<90 min) DCS-measured CBF response to IT nicardipine is associated with intermediate-term (up to 3 weeks) development of DCI.

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