Abstract
Reversible vasoconstriction syndrome is a complex of clinical symptoms and angiographic findings, which, while having a mostly benign clinical course, has clinical and imaging overlap with more serious disorders such as vasculitis and aneurysmal SAH and itself includes a minority of patients with fulminant vasoconstriction resulting in severe intracranial complications. Endovascular options for patients with refractory reversible cerebral vasoconstriction syndrome include intra-arterial vasodilator infusion similar to therapy for patients with vasospasm after SAH. To date, only case reports and 1 small series have discussed the utility of intra-arterial vasodilators for the treatment of reversible cerebral vasoconstriction syndrome. We report an additional series of 11 medically refractory cases of presumed or proved reversible cerebral vasoconstriction syndrome successfully treated with intra-arterial verapamil infusion. Furthermore, we propose that the reversal of vasoconstriction, as seen on angiography, could fulfill a diagnostic criterion.
Highlights
We present 11 patients with documented or presumed Reversible cerebral vasoconstriction syndrome (RCVS) who presented with or progressed to clinically relevant vasoconstriction and in whom IA treatment with verapamil resulted in clinical and radiographic improvement
Individual cases of patients with presumed RCVS who underwent cerebral angiography with intra-arterial administration of verapamil were retrospectively identified through a departmental angiography data base search from 2006–2016 at the University Hospital of Basel, Switzerland; 2006–2016 at AJNR Am J Neuroradiol 41:293–99 Feb www.ajnr.org 293
Similar to the treatment of aneurysmal SAH-induced vasospasm, IA verapamil provided an improvement of the arterial caliber during angiographic studies, and all our patients demonstrated improvement clinically
Summary
Since 2006, the authors have used intra-arterial verapamil as a treatment option in patients with suspected RCVS and clinical deterioration. Individual cases of patients with presumed RCVS who underwent cerebral angiography with intra-arterial administration of verapamil were retrospectively identified through a departmental angiography data base search from 2006–2016 at the University Hospital of Basel, Switzerland; 2006–2016 at AJNR Am J Neuroradiol 41:293–99 Feb www.ajnr.org 293. 5–20 mg per territory (maximum of 20 mg per vessel and 60-mg total dose per session) as described in the treatment of subarachnoid hemorrhage-induced vasospasm by Jun et al[10] and Keuskamp et al.[11] Due to prolonged procedural times because of the slow infusion rate, treatment was performed with monitored anesthesia care with continuous monitoring of systemic blood pressure, heart rate, respiratory frequency, and arterial oxygen saturation. Patients were monitored clinically and with daily transcranial Doppler sonography
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