The Experimental And Clinical Study On The Therapy Of Cerebral Vasospasm By Intracisternal Infusion Of Nicardipine

Objective: To study the therapeutic effects of both intracisternal infusion and intravenous injection of nicardipine solution on rabbits cerebral vasospasm models and to compare the therapeutic effects between these two methods.Method: The primary SAH rabbit models were produced by introducing blood two times to Chiasmatic cistern through frontotemporal craniotomy. The cerebral vasospasm(CVS) rabbit models were treated by both intracisternal infusion and intravenous injection of nicardipine solution. The diameter of basilar arteries were measured by cerebral angiography to evaluate the severity of CVS. The pathological changes of basilar artery walls were examined.Results: The obvious CVS was induced in all the models. Every rabbit had CVS 3 days after SAH. In the placebo group, the average value of CVS was 38.8%. Among them, 20% was mild CVS, 80% was moderate CVS. The degree of CVS reached the top on the 7th day following SAH. The average value of CVS was 55.2%, 40% of them was moderate CVS and 60% was severe CVS. In the intravenous treatment group, 3 days after SAH, 60% was mild CVS and 40% was moderate; 7days after SAH, 40% was mild CVS and 60% was moderate. In the intracisteral treatment group: 80% mild CVS and 20 moderate CVS on the 3rd day after SAH. On the 7th day, mild CVS 60% and moderate CVS 40%. The results indicated that, both intracisternal infusion and intravenous injection of nicardiprine solution can reduce the severity of CVS. Among them, the intracisternal infusion therapy is more effective. The histological examination showed that the obvious morphological changes in the arterial wall of BA were clearly observed within 14 days after SAH. Such as the swell of endothelial cells, the thickening of medial smooth muscle layer and adventitial layer, accompanying with the thickening of arterial wall and the narrowness of vessel cavity. Thepathological changes were most obvious on the 7th day following SAH. All the above changes were reduced after intracisternal infusion of nicardipine. Compared with intravenous injection, the results of intracisternal infusion were more effective.Conclusion: The intracisternal infusion of nicardipine solution in treatment of CVS was useful ..It can reverse the severity of CVS and reverse the pathologic changement in the arterial wall. The intracisternal infusion was more effective compared with intravenous infusion.