Coil herniation following intra-arterial verapamil infusion for the treatment of cerebral vasospasm: Case report and literature review.
Complications associated with intra-arterial infusion of vasodilator agents for the treatment of vasospasm associated with a ruptured cerebral aneurysm are extremely rare. We present the case of a patient who developed left lower extremity monoplegia following intra-arterial infusion of verapamil for treatment of diffuse cerebral vasospasm, 6 days after initially undergoing treatment of a ruptured right A1-2 junction aneurysm. A repeat angiogram following this intra-arterial vasodilator treatment demonstrated a coil loop which had herniated into the right A2 artery. Herein, we describe a previously unreported complication which occurred following intra-arterial pharmacologic vasospasm treatment, review the existing literature, and suggest potential causes and treatment options.
University of Pittsburgh School of Medicine, Pittsburgh, USA.
Stephanie H
SH
Chen
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Ramesh
R
Grandhi
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Christopher P
CP
Deibert
Department of Neurology, University of Pittsburgh Medical Center; Pittsburgh, USA.
Tudor G
TG
Jovin
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Paul A
PA
Gardner
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA ducruetaf@upmc.edu.
Andrew F
AF
Ducruet
D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002343:Carotid Artery, Internal; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation; D006547:Hernia; D006801:Humans; D007261:Infusions, Intra-Arterial; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000150:complications / Q000188:drug therapy*; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D014665:Vasodilator Agents; D014700:Verapamil
Cerebral aneurysm; cerebral vasospasm; coil embolization; coil herniation; stroke; verapamil