Abstract
Endovascular options for therapy for patients with vasospasm after SAH include angioplasty and intra-arterial vasodilator infusion. Preliminary studies of the effects of the calcium channel antagonist verapamil on angiographic vasospasm have yielded mixed and/or qualitative results. In this study, improvement in angiographic vasospasm after intra-arterial verapamil administration is demonstrated with quantitative, blinded methods. This retrospective observational case series includes 12 patients with vasospasm after SAH who collectively received 16 treatments with intra-arterial verapamil during a 2-year period at our institution. The exclusion criterion was concurrent treatment with angioplasty. Blinded reviewers quantitatively evaluated angiograms from each patient and/or treatment after presentation with SAH and before and after intra-arterial treatment of vasospasm. Patients were treated with intra-arterial verapamil for vasospasm 9 ± 4 days after SAH with a range from 1 to 16 days. For the 34 arterial distributions treated, the segment with the worst angiographic vasospasm from each arterial distribution averaged 51 ± 13% stenosis, which improved to 29 ± 18% stenosis (P < .001). There was no significant difference in treatment effect in proximal arterial segments, which may be amenable to angioplasty, compared with distal segments (P > .05). There was no significant difference in treatment effect in arterial segments previously subjected to angioplasty compared with other segments (P > .05). Intra-arterially administered verapamil improves angiographic vasospasm after SAH when administered at 10 ± 3 mg per arterial distribution. Optimal dose, infusion rate, and retreatment interval remain to be determined. Randomized controlled trials are needed to prove efficacy in the treatment of clinical vasospasm.
Highlights
AND PURPOSE: Endovascular options for therapy for patients with vasospasm after SAH include angioplasty and intra-arterial vasodilator infusion
For the 34 arterial distributions treated, the segment with the worst angiographic vasospasm from each arterial distribution averaged 51 Ϯ 13% stenosis, which improved to 29 Ϯ 18% stenosis (P Ͻ .001)
Intra-arterially administered verapamil improves angiographic vasospasm after SAH when administered at 10 Ϯ 3 mg per arterial distribution
Summary
This retrospective observational case series includes 12 patients with vasospasm after SAH who collectively received 16 treatments with intra-arterial verapamil during a 2-year period at our institution. Blinded reviewers quantitatively evaluated angiograms from each patient and/or treatment after presentation with SAH and before and after intra-arterial treatment of vasospasm. This retrospective observational case series included all patients treated with intra-arterial verapamil for cerebral vasospasm between January 1, 2006, and December 31, 2008, at our institution, where follow-up angiography was performed Ն20 minutes after treatment. For vertebral DSA, artery diameters were measured at Յ7 predetermined segments on the anteroposterior view. Because DSA is subject to variability in magnification between angiograms, all artery measurements were scaled to skull diameters
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
