Journal article
Improvement in Angiographic Cerebral Vasospasm after Intra-Arterial Verapamil Administration
American journal of neuroradiology : AJNR, Vol.31(10), pp.1923-1928
2010
DOI: 10.3174/ajnr.A2215
PMID: 20705701
Abstract
BACKGROUND AND PURPOSE: 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. MATERIALS AND 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.
Details
- Title: Subtitle
- Improvement in Angiographic Cerebral Vasospasm after Intra-Arterial Verapamil Administration
- Creators
- J. V SEHY - Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United StatesW. E HOLLOWAY - Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United StatesS.-P LIN - Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United StatesD. T CROSS - Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United StatesC. P DERDEYN - Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United StatesC. J MORAN - Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
- Resource Type
- Journal article
- Publication Details
- American journal of neuroradiology : AJNR, Vol.31(10), pp.1923-1928
- DOI
- 10.3174/ajnr.A2215
- PMID
- 20705701
- NLM abbreviation
- AJNR Am J Neuroradiol
- ISSN
- 0195-6108
- eISSN
- 1936-959X
- Publisher
- American Society of Neuroradiology; Oak Brook, IL
- Language
- English
- Date published
- 2010
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020652902771
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