Efficacy and safety of intraventricular nimodipine in patients with aneurysmal subarachnoid hemorrhage compared to oral nimodipine: a systematic review and meta-analysis.

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Nimodipine is the only drug approved and administered orally as well as intravenously to improve the outcomes of patients with vasospasm post-SAH. EG-1962 is a sustained-release formulation of nimodipine administered into the subarachnoid space in patients with aSAH. We hypothesize that this may improve the efficacy of nimodipine and minimize its adverse effects. We searched PubMed, Cochrane, Scopus, and Web of Science on August 2, 2024, using relevant keywords. Studies were screened for eligibility. We extracted the data from the relevant articles and then these data were pooled as risk ratio (RR) and 95% confidence interval (CI), using R software. Pooled data from trials comparing intraventricular nimodipine with oral nimodipine showed a significantly lower risk of angiographic vasospasm in the intraventricular nimodipine cohort than the oral nimodipine cohort (RR = 0.8, CI [0.65-0.98]), and a trend towards lower risk of delayed cerebral ischemia and hypotension. No significant difference in extended Glasgow coma scale (eGCS) at 90 days of follow-up and other adverse events like hydrocephalus, bacterial meningitis, and serious adverse events including death. The risk of angiographic vasospasm was lower with intraventricular nimodipine compared with oral nimodipine, and there was a trend toward a decreased incidence of DCI and hypotension, which should be validated in future studies. However, there is no significant improvement in functional outcomes from intraventricular nimodipine. More rigorous research is needed to look at the underlying mechanisms and see if other factors influence the functional outcomes. Clinical trial number Not applicable.