Cerebral arterial vasospasm and infarction is the leading cause of death and disability among patients who reach a major medical center after aneurysmal subarachnoid hemorrhage (SAH). Recent evidence suggests that two calcium antagonists, nimodipine or nicardipine, may be useful in preventing this important complication of SAH. This paper reviews the current status of these two calcium antagonists in the management of SAH.
Get full access to this article
View all access options for this article.
References
1.
KassellNF, DrakeCG: Timing of aneurysm surgery. Neurosurgery10: 514–519, 1982.
2.
KassellNF, TornerJC, JaneJA: The International Cooperative Study on the Timing of Aneurysm Surgery. In: International Aneurysms. Surgical Timing and Techniques. Proceedings of the First International Workshop on Intracranial Aneurysms, ed. by KikuchiH, FukuchimaT, WatarabeK.Tokyo: Nishimura, 1986, pp 184–189.
3.
LjunggrenB, BrandtL, KagstromE: Results of early operations for ruptured aneurysms. J Neurosurg54:473–479, 1981.
4.
KassellNF, TornerJC, AdamsHP: Antifibinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage. Preliminary observations from the Cooperative Aneurysm Study. J Neurosurg61: 225–230, 1984.
5.
VermeurlenM, LindsayKW, MurrayGD: Anti-fibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med311:432–437, 1984.
6.
WilkinsRH: Cerebral Arterial Spasm. Baltimore: Williams & Wilkins, 1980.
AaslidR, HuberP, NornesH: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg60:37–41, 1984.
9.
HardersAG, GilsbachJM: Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg66:718–728, 1987.
10.
AdamsHP: Early management of the patient with recent aneurysmal subarachnoid hemorrhage. Stroke17: 1068–1070, 1986.
11.
WilkinsRH: Attempts at prevention or treatment of intracranial arterial spasm. An update. Neurosurgery18:808–825, 1986.
KassellNF, PeerlessSJ, DurwardQJ: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery11:337–343, 1982.
14.
GelmersHJ: The role of calcium and significance of calcium antagonists in some neurological and neurosurgical diseases. Clin Neurol Neurosurg85:213–224, 1983.
15.
WeirB: Calcium antagonists, cerebral ischemia and vasospasm. Can J Neurol Sci11:239–246, 1984.
16.
AllenGS: Role of calcium antagonists in cerebral arterial spasm. Am J Cardiol55:149B–153B, 1985.
17.
SorkinEM, ClissoldSP: Nicardipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in the treatment of angina pectoris, hypertension and related cardiovascular disorders. Drugs33:296–345, 1987.
18.
PrzuntekHV, BaumgartenF, MertensHG: Treatment of vasospasm due to subarachnoid hemorrhage with calcium entry blockers. Eur Neurol25 (Suppl 1): 86–92, 1986.
19.
BaethmannA, JansenM: Possible role of calcium blockers in brain protection. Eur Neurol25 (Suppl 1): 102–114, 1986.
20.
PetersT: Calcium in physiological and pathological cell function. Eur Neurol25 (Suppl 1): 27–44, 1986.
GreenbergDA: Calcium channels and calcium channel antagonists. Ann Neurol21:317–330, 1987.
23.
GrottaJ, SpydellJ, PettigrewC: The effect of nicardipine on neuronal function following ischemia. Stroke17:213–219, 1986.
24.
GrottaJC, PettigrewLC, RosenbaumD: Efficacy and mechanism of action of a calcium channel blocker after global cerebral ischemia in rats. Stroke19:447–454, 1988.
25.
LeblancR, FeindelW, YamamotoL: Reversal of acute experimental cerebral vasospasm by calcium antagonism with verapamil. Can J Neurol Sci11:42–47, 1984.
26.
ArbitE, KaplanR, GillichA: Can calcium antagonists affect the hemostatic mechanism and promote rebleeding? An experimental study. Neurosurgery20:732–734, 1987.
27.
GelmersHJ, GorterK, DeWeerdtCJ: A controlled trial of nimodipine in acute ischemic stroke. N Engl J Med318:203–207, 1988.
28.
AuerLM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery15:57–66, 1984.
29.
LjunggrenB, BrandtL, SavelandH: Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg61:864–873, 1984.
30.
SavelandH, LjunggrenB, BrandtL: Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine. Neurosurgery1:146–150, 1986.
31.
BrandtL, LjunggrenB, SavelandH: Use of a calcium antagonist in aneurysmal subarachnoid hemorrhage. Ann NY Acad Sci522:667–675, 1988.
32.
KaznerE, SprungC, AdeltD: Clinical experience with nimodipine in the prophylaxis of neurological deficits after subarachnoid hemorrhage. Neurochirurgia28:110–113, 1985.
33.
KoosWT, PerneczkyA, AuerLM: Nimodipine treatment of ischemic neurological deficits due to cerebral vasospasm after subarachnoid hemorrhage. Clinical results of a multicenter study. Neurochirurgia28:114–117, 1985.
34.
GrotenhuisJA, BettagW: Prevention of symptomatic vasospasm after SAH by constant venous infusion of nimodipine. Neurol Res8:243–249, 1986.
35.
BokerDK, SolymosiL, WassmannH: Immediate post-angiographic intraarterial treatment of cerebral vasospasm after subarachnoid hemorrhage with nimodipine. Neurochirurgia28:118–120, 1985.
36.
GrotenhuisJA, BettagW, FiebachBJO,: intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. J Neurosurg61:231–240, 1984.
37.
AllenGS, AhnHS, PreziosiTJ: Cerebral arterial spasm. A controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med308:619–624, 1983.
38.
TettenbornD, PortoL, RymanT: Survey of clinical experience with nimodipine in patients with subarachnoid hemorrhage. Neurosurg Rev10:77–84, 1987.
39.
Neil-DwyerG, MeeE, DorranceD: Early intervention with nimodipine in subarachnoid hemorrhage. Eur Heart J8 (Suppl K): 41–47, 1987.
40.
MeeE, DorranceD, LoweD: Controlled study of nimodipine in aneurysm patients treated early after subarachnoid hemorrhage. Neurosurgery22:484–491, 1988.
41.
PetrukKC, WestM, MohrG: Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo controlled trial. J Neurosurg68:505–517, 1988.
42.
TaylorSH, SilkeB, AhujaRC: Influence of nicardipine on the blood pressure at rest and on the pressor response to cold, isometric exertion and dynamic exercise in hypertensive patients. J Cardiovasc Pharmacol4:803–807, 1982.
43.
MatsuiM, NishiwakiH, YoshinoJ: Effects of nicardipine hydrochloride on the conduction system of the heart in man. Jpn Heart J23 (Suppl 1): 243–245, 1982.
44.
GreerIA, WalkerJJ, McLarenM: Inhibition of whole blood platelet aggregation by nicardipine and synergism with prostacyclin in vitro. Thromb Res41:509–518, 1986.
45.
GrottaJC, PettigrewLC, LockwoodAH: Brain extraction of a calcium channel blocker. Ann Neurol21:171–175, 1987.
46.
HguchiS, ShiobaraY: Comparative pharmacokinetics of nicardipine hydrochloride, a new vasodilator in various species. Xenobiotica10:447–454, 1980.
47.
HandaJ, MatsudaM, NakasuY: Early operation of aneurysmal subarachnoid hemorrhage. Use of nicardipine, a calcium channel blocker. Arch Jpn Chir53:619–630, 1984.
48.
FlammES, AdamsHPJr, BeckDW: Dose escalation study of intravenous nicardipine in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg68:393–400, 1988.
49.
BeckDW, AdamsHPJr, FlammES: Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage. Stroke19:63–67, 1988.
