Abstract Details

Title Assessing Effects of Intrathecal Nicardipine on Cerebral Autoregulation and Cortical Activity in Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-019

Objective Characterize the effects of intrathecal nicardipine (ITN) on cerebrovascular function as measured by cerebral autoregulation and cortical activity on quantitative electroencephalography (qEEG) in aneurysmal subarachnoid hemorrhage (aSAH).

Background aSAH is a life-threatening condition after which patients are at risk for vasospasm and delayed cerebral ischemia. ITN is an emerging bedside treatment in critically ill aSAH patients with vasospasm. ITN’s impact on cerebral physiology, including the interactions between autoregulation and qEEG changes, are not well understood.

Design/Methods We retrospectively evaluated near-infrared spectroscopy (NIRS), mean arterial pressure (MAP), and qEEG continuously collected in aSAH patients undergoing ITN administration. Autoregulatory function was measured by interrogating changes in NIRS-derived tissue oxygenation in response to changes in MAP. Cortical activity was measured by computing percent changes in each qEEG frequency band after artifact reduction and feature extraction. Analyses were restricted to 2 hours pre and 5 hours post ITN to minimize potential for interference given dosing schedules.

Results We calculated upper and lower limits of autoregulation (ULA, LLA) and percent changes in qEEG for 68 ITN administrations across 14 patients (median age 59 ± 11 years, Hunt Hess 3.0 ± 0.9, modified Fisher 4.0 ± 0.5). After ITN, patients spent 8.08% less time above ULA (p = 0.04) and 5.28% more time below LLA (p = 0.003). 69.1% (n = 47) of ITN administrations showed a subsequent change in absolute power in the delta band ≥5%. Similar patterns were found in alpha power (n = 43, 63.2%), total power (n = 44, 64.7%), and alpha/delta ratio (n = 36, 52.9%).

Conclusions ITN administration was associated with shifts in the autoregulatory curve and changes in cortical activity as measured by qEEG. Autoregulatory shifts were not associated with a consistent EEG signature, which suggests other factors may play a significant role. Further exploratory analyses are on-going.

Authors/Disclosures
Sithmi M. Jayasundara PRESENTER	Miss Jayasundara has nothing to disclose.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.
Rachel S. Choi (Yale School of Medicine)	Ms. Choi has nothing to disclose.
Amedeo Rapuano (Yale New Haven Hospital)	Amedeo Rapuano has nothing to disclose.
Erin Barnes, MD (Albany Medical Center)	An immediate family member of Dr. Barnes has received personal compensation for serving as an employee of Go2For Lung Cancer. The institution of Dr. Barnes has received research support from NIH.
Melvin Parasram, DO	Dr. Parasram has nothing to disclose.
Michele Moura (Yale New Haven Hospital)	No disclosure on file
Puneet Uppal (Yale University School of Medicine)	No disclosure on file
Yilun Chen (Yale University)	Ms. Chen has nothing to disclose.
Ilayda Top (Yale University)	Ms. Top has nothing to disclose.
Madelynne Olexa	Miss Olexa has nothing to disclose.
Rafael Maarek	Mr. Maarek has received research support from National Heart Lung & Blood Institute. Mr. Maarek has received research support from Richard K. Gershon Endowed Medical Student Research Fellowship.
Jennifer Yan	No disclosure on file
Rachel Beekman, MD (Yale New Haven Medical Center)	Dr. Beekman has nothing to disclose.
Jessica Magid-Bernstein, MD, PhD (Yale School of Medicine)	Dr. Magid-Bernstein has nothing to disclose.
Ryan Hebert	Ryan Hebert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus .
Farhad Bahrassa (Yale Department of Neurosurgery)	Farhad Bahrassa has nothing to disclose.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Nils Petersen, MD, FAAN (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.

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