Trial of Treatment of Vasospasm Associated With Aneurysmal Subarachnoid Hemorrhage With Intrathecal Injection of Nicardipine: a Multi-center, Prospective, Double-blinded, Randomized Controlled Trial
To investigate whether patients with cerebral vasospasm associated with aneurysmal subarachnoid hemorrhage have a better prognosis with intrathecal nicardipine injection via extraventricular drainage or lumbar drainage.
• Age 18-80.
• Spontaneous SAH confirmed by head CT.
• Saccular brain aneurysm is identified and treated, either surgically or endovascularly.
• SAH Fisher grade \>1 or modified Fisher grade \>0.
• EVD placed for acute hydrocephalus, or LD placed for draining bloody CSF as deemed necessary by the treating physician.
• Any clinical scenario leading to the diagnosis of possible vasospasm, which includes:
‣ Mean flow velocity of MCA \>120, or Lindegaard Ratio ( LR ) \> 3.
⁃ Any intracranial artery including MCA, ACA, PCA, and BA, TCD showed an upward trend of mean flow velocity for 2 consecutive days (\>25cm/s/day).
⁃ Clinical deterioration including mental status change (GCS score decrease \> 2) and focal neurological deficit unable to be attributed to other known neurological reasons.
⁃ Evidence of vasospasm on CTA or DSA, or ischemic change by CTP, MRI.
• Within 14 days of onset of SAH.
• Informed consent obtained from the patient or family member.