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

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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.

Patient data summary

No.	Post-SAH Day	Age (yr)	Sex	HH Grade	Fisher Group	Aneurysm Location, Treatment	Vessel	Vasospasm Grading	Vasospasm Treatment	MTT Pre-Rx	MTT Post-Rx	CBF Pre-Rx	CBF Post-Rx	CBV Pre-Rx	CBV Post-Rx
1	5	62	M	4	3	BA, coiling	R MCA	Mod/sev	10 mg, R ICA	5.59	5.29	32.69	43.57	2.35	2.97
							L MCA	Severe	10 mg, L ICA	5.50	4.95	38.52	45.34	2.53	2.91
							R PCA	Severe	10 mg, BA	6.27	6.29	29.39	28.32	2.02	2.16
							L PCA	Severe		8.25	5.91	22.01	35.71	2.12	2.61
2	4	44	F	3	3	L ACA, coiling	R MCA	Mild	4 mg, R ICA	5.08	2.24	36.08	58.63	2.20	2.04
							R ACA	Severe	PTA, R ICA	7.23	2.18	21.86	57.25	1.98	1.99
									PTA, R M1
							L MCA	Moderate	4 mg, L ICA	6.14	2.42	36.19	50.12	2.75	1.81
							L ACA	Severe	PTA, L ICA	7.95	2.52	19.67	37.25	1.97	1.36
									2 mg, L A1
									PTA, L A1
3	11	55	F	2	3	No aneurysm identified	R MCA	Moderate	4 mg R ICA	4.79	4.44	45.26	56.11	2.79	3.38
							R ACA	Severe	2 mg, R A1	5.88	5.05	37.51	58.60	2.89	4.15
							L MCA	Moderate	4 mg, L ICA	7.99	5.07	30.75	51.91	3.29	3.55
							L ACA	Mild	2 mg L M2	6.16	5.33	38.89	45.71	3.23	3.43
4	5	44	F	3	3	BA, clipping	R MCA^*	Moderate	8 mg, R ICA	5.33	4.83	48.78	48.90	3.36	3.02
							L MCA	Moderate	6 mg, L ICA	4.19	3.46	57.92	77.14	3.31	3.77
5	11	42	M	2	3	AcomA, clipping	R MCA	None	None^†	5.29	5.09	47.46	43.25	3.23	2.90
							L MCA	Moderate	7.5 mg, L ICA	5.32	4.27	68.20	73.73	4.71	4.32

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.