Shah Qaisar A, Georgiadis Alexandros, Suri M Fareed K, Rodriguez Gustavo, Qureshi Adnan I
Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Neurocrit Care. 2007;7(1):53-7. doi: 10.1007/s12028-007-0035-7.
To report experience with intra-arterial (IA) calcium channel blocker (nicardipine) in patients with acute ischemic stroke with and without reteplase, mechanical thrombectomy (snare), and primary angioplasty to achieve maximal recanalization. Selective delivery of calcium channel blocker may improve perfusion and possibly provide neuroprotection in cerebral ischemia.
We performed a retrospective study to determine the angiographic and clinical outcomes among patients treated with IA nicardipine administered as 2.5-5 mg dose either alone or adjunct to intra-arterial thrombolysis. Mean arterial pressure and heart rate were recorded throughout the injection. Angiographic severity of initial occlusion and recanalization was assessed using the Qureshi grading scheme. Neurological examinations and computed tomographic scans were performed prior to, immediately, and 24 h after thrombolysis for each patient, to assess the neurological improvement and symptomatic or asymptomatic intracranial hemorrhages.
Ten patients median age of 60 years (age range: 35-93 years) were administered IA nicardipine. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 14 (range 6-19). All patients received IA nicardipine either in combination with thrombolytics (n = 6) or as monotherapy (n = 4). The average decrease in mean arterial pressure (MAP) was 10 mmHg; except one patient who had an asymptomatic decline of 34 mm Hg, which responded to fluid resuscitation. None of the patients suffered any procedural and post-procedural complication. Overall recanalization (improvement in one grade or greater) was observed in 2 of 10 patients with IA nicardipine with or without thrombolytic treatment. Other angiographic changes observed included improvement in collateral flow (n = 2), increase in transit time (n = 1), and vasodilation of distal arteries and branches (n = 4). No patient demonstrated any worsening from the baseline grade in response to IA nicardipine. Of the two patients who underwent serial magnetic resonance imaging (MRI) and one patient demonstrated reversal of pretreatment restricted diffusion. Neurological improvement defined by a decrease of four points or greater was observed in four patients at 24 h following treatment.
Intra-arterial delivery of nicardipine in doses up to 5 mg is well tolerated among patients with acute ischemic stroke. Further studies are required to determine the potential efficacy of this approach with or without thrombolytics.
报告动脉内（IA）注射钙通道阻滞剂（尼卡地平）治疗急性缺血性卒中患者的经验，这些患者接受或未接受瑞替普酶、机械取栓术（圈套器）及直接血管成形术以实现最大程度的再通。选择性给予钙通道阻滞剂可能改善灌注，并可能在脑缺血中提供神经保护作用。
我们进行了一项回顾性研究，以确定单独或作为动脉内溶栓辅助治疗给予2.5 - 5 mg剂量IA尼卡地平的患者的血管造影和临床结局。在注射过程中记录平均动脉压和心率。使用Qureshi分级方案评估初始闭塞和再通的血管造影严重程度。对每位患者在溶栓前、溶栓即刻及溶栓后24小时进行神经学检查和计算机断层扫描，以评估神经功能改善情况以及有症状或无症状的颅内出血情况。
10例患者接受了IA尼卡地平治疗，中位年龄60岁（年龄范围：35 - 93岁）。入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数为14分（范围6 - 19分）。所有患者接受IA尼卡地平治疗，其中6例联合溶栓治疗，4例为单药治疗。平均动脉压（MAP）平均下降10 mmHg；除1例患者出现34 mmHg的无症状下降，经液体复苏后恢复。所有患者均未出现任何操作及操作后并发症。10例接受IA尼卡地平治疗的患者中，无论是否接受溶栓治疗，有2例实现了总体再通（改善一个等级或更高）。观察到的其他血管造影变化包括侧支循环改善（2例）、通过时间增加（1例）以及远端动脉和分支血管扩张（4例）。没有患者因IA尼卡地平治疗而出现基线等级恶化。在接受系列磁共振成像（MRI）检查的2例患者中，1例显示治疗前弥散受限逆转。治疗后24小时，4例患者神经功能改善，定义为NIHSS评分下降4分或更多。
急性缺血性卒中患者接受高达5 mg剂量的IA尼卡地平治疗耐受性良好。需要进一步研究以确定这种方法联合或不联合溶栓治疗的潜在疗效。
