Evaluating the effectiveness of nicardipine prolonged-release implants in patients with subarachnoid hemorrhage: a meta-analysis and meta-regression analysis.

Abstract

<h4>Introduction and importance</h4>Subarachnoid hemorrhage (SAH) is a critical condition with high morbidity and mortality, often complicated by cerebral vasospasm and delayed cerebral ischemia (DCI). Nicardipine, a calcium channel blocker, has shown promise in mitigating these risks. This meta-analysis evaluates the effectiveness and safety of nicardipine prolonged-release implants in reducing SAH complications.<h4>Methods</h4>A comprehensive literature search was conducted in PubMed, Cochrane Library, Embase, and ClinicalTrials.gov, identifying seven eligible studies involving 775 patients with SAH. Randomized controlled trials (RCTs) and observational studies were included. The primary outcome was the incidence of cerebral vasospasm, while secondary outcomes included DCI and delayed ischemic neurologic deficit (DIND). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects meta-analysis.<h4>Results</h4>Nicardipine implants significantly reduced the risk of cerebral vasospasm (RR = 0.38, 95% CI [0.23, 0.61], <i>P</i> < 0.0001) and DCI (RR = 0.33, 95% CI [0.18, 0.58], <i>P</i> = 0.0002). However, no significant effect was observed on DIND (RR = 0.68, 95% CI [0.33, 1.39], <i>P</i> = 0.29) or functional outcomes (modified Rankin scale; RR = 2.03, 95% CI [0.85, 4.87], <i>P</i> = 0.11).<h4>Conclusion</h4>Nicardipine prolonged-release implants are effective in reducing the incidence of cerebral vasospasm and DCI in SAH patients, with potential benefits in preventing these complications. However, they do not significantly impact functional outcomes, indicating the need for complementary rehabilitation strategies. Further large-scale studies are needed to confirm these findings.