Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

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dc.authorscopusidAbuzer Güngör / 54895233300
dc.authorwosidAbuzer Güngör / KNR-5035-2024
dc.contributor.authorLuzzi, Sabino
dc.contributor.authorBektaşoğlu, Pınar Kuru
dc.contributor.authorDoğruel, Yücel
dc.contributor.authorGüngör, Abuzer
dc.date.accessioned2025-04-18T10:16:46Z
dc.date.available2025-04-18T10:16:46Z
dc.date.issued2024
dc.departmentİstinye Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü
dc.description.abstractThe clinical management of aneurysmal subarachnoid hemorrhage (SAH)-associated vasospasm remains a challenge in neurosurgical practice, with its prevention and treatment having a major impact on neurological outcome. While considered a mainstay, nimodipine is burdened by some non-negligible limitations that make it still a suboptimal candidate of pharmacotherapy for SAH. This narrative review aims to provide an update on the pharmacodynamics, pharmacokinetics, overall evidence, and strength of recommendation of nimodipine alternative drugs for aneurysmal SAH-associated vasospasm and delayed cerebral ischemia. A PRISMA literature search was performed in the PubMed/Medline, Web of Science, ClinicalTrials.gov, and PubChem databases using a combination of the MeSH terms "medical therapy," "management," "cerebral vasospasm," "subarachnoid hemorrhage," and "delayed cerebral ischemia." Collected articles were reviewed for typology and relevance prior to final inclusion. A total of 346 articles were initially collected. The identification, screening, eligibility, and inclusion process resulted in the selection of 59 studies. Nicardipine and cilostazol, which have longer half-lives than nimodipine, had robust evidence of efficacy and safety. Eicosapentaenoic acid, dapsone and clazosentan showed a good balance between effectiveness and favorable pharmacokinetics. Combinations between different drug classes have been studied to a very limited extent. Nicardipine, cilostazol, Rho-kinase inhibitors, and clazosentan proved their better pharmacokinetic profiles compared with nimodipine without prejudice with effective and safe neuroprotective role. However, the number of trials conducted is significantly lower than for nimodipine. Aneurysmal SAH-associated vasospasm remains an area of ongoing preclinical and clinical research where the search for new drugs or associations is critical.
dc.description.sponsorshipUniversita degli Studi di Pavia with-in the CRUI-CARE Agreement
dc.identifier.citationLuzzi, S., Bektaşoğlu, P. K., Doğruel, Y., & Güngor, A. (2024). Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia. Neurosurgical Review, 47(1), 305.
dc.identifier.doi10.1007/s10143-024-02543-5
dc.identifier.endpage19
dc.identifier.issn0344-5607
dc.identifier.issn1437-2320
dc.identifier.issue1
dc.identifier.scopus2-s2.0-85197682239
dc.identifier.scopusqualityQ1
dc.identifier.startpage1
dc.identifier.urihttp://dx.doi.org/10.1007/s10143-024-02543-5
dc.identifier.urihttps://hdl.handle.net/20.500.12713/7010
dc.identifier.volume47
dc.identifier.wosWOS:001262952100001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorGüngör, Abuzer
dc.institutionauthoridAbuzer Güngör / 0000-0002-2792-7610
dc.language.isoen
dc.publisherSpringer
dc.relation.ispartofNeurosurgical review
dc.relation.publicationcategoryDiğer
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCalcium Channel Blockers
dc.subjectCerebral Vasospasm
dc.subjectDelayed Cerebral Ischemia
dc.subjectNimodipineRho-Kinase Inhibitors
dc.subjectSubarachnoid Hemorrhage
dc.titleBeyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia
dc.typeOther

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