This study aimed to determine the impact of intrathecal (IT) nicardipine on outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH) experiencing moderate to severe vasospasms.

Vasospasm is a common complication in aSAH patients that causes significant morbidity and mortality. A recent trend in IT nicardipine use has been reported in treating vasospasm post-aSAH but its effect on patient outcomes is under-researched. We sought to determine the safety and impact of intrathecal nicardipine on outcomes.

We conducted a single-center, retrospective study of aSAH patients from 2016 to 2024. Patients with moderate or severe vasospasm diagnosed using transcranial Doppler or cerebral angiography were included. We tested the association of IT nicardipine with outcomes including modified Rankin Scale at 90 days post-discharge, vasopressor use, ICU length of stay, and external ventricular drain (EVD) duration. Spearman’s rank correlation, Kruskal-Wallis test, Chi-squared test of independence, Fisher’s exact test, and multivariate linear regression were used for statistical comparisons.

We reviewed 450 aSAH patients, including N=122 in our final analysis (mean [SD] age, 50.2 [12.28]; 64.8% female). 20 patients (16.4%) received IT nicardipine. IT nicardipine was less likely used in patients treated with coiling or pipeline devices (p=0.013) while more likely used in patients treated with stent-assisted coils, balloon-assisted coils, or clipping (p=0.013). IT nicardipine was not independently associated with functional outcomes, vasopressor use, EVD duration, or ICU length of stay. IT nicardipine had no effect on the need to escalate to endovascular vasospasm therapy. 

While IT nicardipine does not increase EVD duration or lengthen ICU stay, our study is underpowered to determine whether patients with moderate to severe vasospasm may benefit from IT nicardipine. Larger prospective studies are needed to identify patient subgroups that would benefit from IT nicardipine. Further research is required to investigate endovascular/surgical aSAH procedures that may complement IT nicardipine in improving outcomes.