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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleBrain

Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm

R.G. Nogueira, M.H. Lev, L. Roccatagliata, J.A. Hirsch, R.G. Gonzalez, C.S. Ogilvy, E.F. Halpern, G.A. Rordorf, J.D. Rabinov and J.C. Pryor
American Journal of Neuroradiology January 2009, 30 (1) 160-164; DOI: https://doi.org/10.3174/ajnr.A1275
R.G. Nogueira
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M.H. Lev
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L. Roccatagliata
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J.A. Hirsch
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R.G. Gonzalez
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C.S. Ogilvy
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E.F. Halpern
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G.A. Rordorf
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J.D. Rabinov
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J.C. Pryor
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    Fig 1.

    Panels 1, 2, and 3 illustrate cases 1, 2, and 3, respectively. Panels A–D show pre- and posttreatment angiograms and MTT maps, respectively. Panel 1: A, Severe vasospasm of the left PCA, which had a marked response to nicardipine infusion in the basilar artery (1B) resulting in 28% reduction in MTT (1C, -D) and 62% increase in CBF (not shown) at the left PCA territory. Panel 2: A, Severe vasospasm of the left ACA, which had a marked response to PTA of the A1 segment and nicardipine infusion (2B), resulting in 68% reduction in MTT (2C, -D) and 89% increase in CBF (not shown) at the left ACA territory. Panel 3: A, Moderate vasospasm of the left MCA, which had only a mild angiographic response to nicardipine infusion (3B). C and D, Despite the suboptimal angiographic result, there was a 37% reduction in MTT and 69% increase in CBF (not shown) at the left MCA territory. This likely reflects the nicardipine effect in the microcirculation.

Tables

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  • Patient data summary

    No.Post-SAH DayAge (yr)SexHH GradeFisher GroupAneurysm Location, TreatmentVesselVasospasm GradingVasospasm TreatmentMTT Pre-RxMTT Post-RxCBF Pre-RxCBF Post-RxCBV Pre-RxCBV Post-Rx
    1562M43BA, coilingR MCAMod/sev10 mg, R ICA5.595.2932.6943.572.352.97
    L MCASevere10 mg, L ICA5.504.9538.5245.342.532.91
    R PCASevere10 mg, BA6.276.2929.3928.322.022.16
    L PCASevere8.255.9122.0135.712.122.61
    2444F33L ACA, coilingR MCAMild4 mg, R ICA5.082.2436.0858.632.202.04
    R ACASeverePTA, R ICA7.232.1821.8657.251.981.99
    PTA, R M1
    L MCAModerate4 mg, L ICA6.142.4236.1950.122.751.81
    L ACASeverePTA, L ICA7.952.5219.6737.251.971.36
    2 mg, L A1
    PTA, L A1
    31155F23No aneurysm identifiedR MCAModerate4 mg R ICA4.794.4445.2656.112.793.38
    R ACASevere2 mg, R A15.885.0537.5158.602.894.15
    L MCAModerate4 mg, L ICA7.995.0730.7551.913.293.55
    L ACAMild2 mg L M26.165.3338.8945.713.233.43
    4544F33BA, clippingR MCA*Moderate8 mg, R ICA5.334.8348.7848.903.363.02
    L MCAModerate6 mg, L ICA4.193.4657.9277.143.313.77
    51142M23AcomA, clippingR MCANoneNone†5.295.0947.4643.253.232.90
    L MCAModerate7.5 mg, L ICA5.324.2768.2073.734.714.32
    • Note:—HH indicates Hunt and Hess; Rx, treatment; R, right; L, left; BA, basilar artery; Mod/sev, moderate to severe; AcomA, anterior communicating artery; MTT, mean transit time; CBF, cerebral blood flow; CBV, cerebral blood volume; ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery; ICA, internal carotid artery.

    • * Near-complete occlusion of the M2 segment of the right MCA on angiographic evaluation with only minimal angiographic response after IA nicardipine infusion.

    • † Procedure aborted due to seizures.

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American Journal of Neuroradiology: 30 (1)
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Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm
R.G. Nogueira, M.H. Lev, L. Roccatagliata, J.A. Hirsch, R.G. Gonzalez, C.S. Ogilvy, E.F. Halpern, G.A. Rordorf, J.D. Rabinov, J.C. Pryor
American Journal of Neuroradiology Jan 2009, 30 (1) 160-164; DOI: 10.3174/ajnr.A1275
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R.G. Nogueira, M.H. Lev, L. Roccatagliata, J.A. Hirsch, R.G. Gonzalez, C.S. Ogilvy, E.F. Halpern, G.A. Rordorf, J.D. Rabinov, J.C. Pryor
Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm
American Journal of Neuroradiology Jan 2009, 30 (1) 160-164; DOI: 10.3174/ajnr.A1275

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