Improvement in angiographic cerebral vasospasm after intra-arterial verapamil administration.
OBJECTIVE
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.


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.


RESULTS
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).


CONCLUSIONS
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.
Sehy
J V
JV
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA. sehyj1@yahoo.com
Holloway
W E
WE
Lin
S-P
SP
Cross
D T
DT
Derdeyn
C P
CP
Moran
C J
CJ
D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D014700:Verapamil / Q000008:administration & dosage*; D055815:Young Adult
D002121:Calcium Channel Blockers; D014700:Verapamil