EFFECT OF CALCITONIN-GENE-RELATED PEPTIDE IN PATIENTS WITH DELAYED POSTOPERATIVE CEREBRAL-ISCHEMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

IC BAILEY, JA LYTTLE, B MATTHEW, G BRAADVEDT, RJ NELSON, G STRANJALIS, JP CASTEL, JM ORGOGOZO, AM AZIZ, TF BUCKLEY, RG GALVIN, A KESHTGAR, JC MARKS, J HUTCHISON, SA OLAOIRE, J SINGH, JD MILLER, GD MURRAY, I. BONE, GM TEASDALED GROSSET, P FOY, PRD HUMPHREY, K MORRIS, MDM SHAW, BA BELL, FG JOHNSTON, S. R. STAPLETON, WAS TAYLOR, J.R. BARTLETT, D DORRANCE, RW GULLAN, IJA ROBERTSON, L CALANDRE, RD LOBATO, M BARNES, U CHOKSEY, JA COZENS, J MCMAHON, AD MENDELOW, DT HOPE, D JEFFERSON, B WHITE, Y KEREVAL, D MOHAN, PS DIAS, S HOWELL, J JAKUBOWSKI, B MARTIN, J MARTIN, JD PICKARD, J STANLEY, J LAGARRIGUE, V LARRUE, OP DAHL, R JUUL

Research output: Contribution to journalArticlepeer-review

Abstract

The finding that the carotid vascular beds are sensitive to the potent vasodilator calcitonin-gene-related peptide (CGRP) suggested that the drug might help to prevent ischaemic deterioration after surgery for aneurysmal subarachnoid haemorrhage (SAH). The results of a preliminary study were encouraging, so we have carried out a randomised multicentre single-blind comparison of CGRP and standard best management in patients with ischaemic deficits after surgery for ruptured intracranial aneurysms.

Patients aged 18-70 years in whom a focal neurological deficit developed or who had a reduction of 2 or more points on the Glasgow coma scale (GCS) after surgery entered the study after computed tomography had excluded non-ischaemic causes for the neurological deficit. 62 patients were randomly assigned an infusion of 0.6-mu-g/min CGRP for 4 h, then up to a maximum of 10 days, and 55 patients standard best management (controls). GCS and haemodynamic variables were assessed during the hospital stay, and all patients were followed up at 3 months by an independent investigator, who was unaware of their treatment. Outcome, measured on the Glasgow outcome scale, at 3 months was good in 66% of those treated with CGRP and 60% in the controls; the relative risk of a poor outcome in CGRP-treated patients was 0.88 (95% confidence interval 0.60 to 1.28). Hypotension was a common side-effect of the CGRP infusion. 66% of the CGRP group did not complete treatment because of adverse events (19 patients), lack of improvement at 4 h (17 patients) or later (4 patients), or patient's request (1 patient).

Although we could not show a significant beneficial effect of CGRP in this trial, the wide confidence interval for the risk of a poor outcome and the fact that only a third of patients completed treatment mean that a clinically useful benefit cannot yet be ruled out.

Original languageEnglish
Pages (from-to)831-834
Number of pages4
JournalThe Lancet
Volume339
Issue number8797
Publication statusPublished - 4 Apr 1992

Keywords

  • NERVE-FIBERS
  • HEMORRHAGE
  • VOLUNTEERS
  • CGRP

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