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

• Type of Material: Article
• Authors: Eashani Sathialingam, Emory University; Kyle R Cowdrick, Emory University; Amanda Y Liew, Emory University; Zhou Fang, Emory University; Seung Lee, Emory University; Courtney E McCracken, Kaiser Permanente Georgia, Atlanta; Feras Akbik, Emory University; Owen Samuels, Emory University; Prem Kandiah, Emory University; Ofer Sadan, Emory University; Erin Buckley, Emory University
• Language: English
• Date: 2023-03-17
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Sathialingam, Cowdrick, Liew, Fang, Lee, McCracken, Akbik, Samuels, Kandiah, Sadan and Buckley.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fneur.2023.1052232
• Title of Journal or Parent Work: FRONTIERS IN NEUROLOGY
• Volume: 14
• Start Page: 1052232
• End Page: 1052232
• Grant/Funding Information: This study was supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002378 and R01NS130036-01 (OS), and 1F31HL154703-01A1 (ES).
• Keywords: blood flow; CLINICAL-TRIALS; subarachnoid hemorrhage; VELOCITY; DIFFUSE CORRELATION SPECTROSCOPY; Science & Technology; vasospasm; nicardipine; diffuse correlation spectroscopy; Neurosciences & Neurology; ARTERY; ANEURYSMAL SUBARACHNOID HEMORRHAGE; HEMOGLOBIN; Clinical Neurology; VASOSPASM; Neurosciences; OUTCOME EVENT; Life Sciences & Biomedicine
• Research Categories: Engineering, Biomedical

Abstract

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.