Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome

J M Sequeiros; J A Roa; R P Sabotin; S Dandapat; S Ortega-Gutierrez; E C Leira; C P Derdeyn; G Bathla; D M Hasan; E A Samaniego

doi:10.3174/ajnr.A6772

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Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome

Journal article

Open access

Peer reviewed

Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome

J M Sequeiros, J A Roa, R P Sabotin, S Dandapat, S Ortega-Gutierrez, E C Leira, C P Derdeyn, G Bathla, D M Hasan and E A Samaniego

American journal of neuroradiology : AJNR, Vol.41(10), pp.1869-1875

10/2020

DOI: 10.3174/ajnr.A6772

PMID: 32943423

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Abstract

There is mounting evidence supporting the benefit of intra-arterial administration of vasodilators in diagnosing reversible cerebral vasoconstriction syndrome. We prospectively quantified the degree of luminal diameter dilation after intra-arterial administration of verapamil and its accuracy in diagnosing reversible cerebral vasoconstriction syndrome. Patients suspected of having intracranial arteriopathy on noninvasive imaging and referred for digital subtraction angiography were enrolled in a prospective registry. Intra-arterial verapamil was administered in vascular territories with segmental irregularities. The caliber difference (Caliber - Caliber ) and the proportion of caliber change ([(Caliber - Caliber )/Caliber ] × 100%) were used to determine the response to verapamil. The diagnosis of reversible cerebral vasoconstriction syndrome was made on the basis of clinical and imaging features at a follow-up appointment, independent of the reversibility of verapamil. Receiver operating characteristic curve analysis was performed to determine the best threshold. Twenty-six patients were included, and 9 (34.6%) were diagnosed with reversible cerebral vasoconstriction syndrome. A total of 213 vascular segments were assessed on diagnostic angiography. Every patient with a final diagnosis of reversible cerebral vasoconstriction syndrome responded to intra-arterial verapamil. The maximal proportion of change ( < .001), mean proportion of change ( = .002), maximal caliber difference ( = .004), and mean caliber difference ( = .001) were statistically different between patients with reversible cerebral vasoconstriction syndrome and other vasculopathies. A maximal proportion of change ≥32% showed a sensitivity of 100% and a specificity of 88.2% to detect reversible cerebral vasoconstriction syndrome (area under the curve = 0.951). The Reversible Cerebral Vasoconstriction Syndrome-2 score of ≥5 points achieved a lower area under the curve (0.908), with a sensitivity of 77.8% and a specificity of 94.1%. Objective measurement of the change in the arterial calibers after intra-arterial verapamil is accurate in distinguishing reversible cerebral vasoconstriction syndrome from other vasculopathies. A proportion of change ≥32% has the best diagnostic performance.

Vasodilator Agents - pharmacology

Humans

Middle Aged

Adult

Female

Male

Vasoconstriction - drug effects

Verapamil - pharmacology

Angiography, Digital Subtraction

Infusions, Intra-Arterial

Vasospasm, Intracranial - diagnosis

Details

Title: Subtitle: Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome
Creators: J M Sequeiros - From the Department of Neurology (J.M.S., J.A.R., R.P.S., S.D., S.O.-G., E.C.L., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
J A Roa - Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
R P Sabotin - From the Department of Neurology (J.M.S., J.A.R., R.P.S., S.D., S.O.-G., E.C.L., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
S Dandapat - From the Department of Neurology (J.M.S., J.A.R., R.P.S., S.D., S.O.-G., E.C.L., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
S Ortega-Gutierrez - Department of Radiology (S.O.-G., C.P.D., G.B., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
E C Leira - From the Department of Neurology (J.M.S., J.A.R., R.P.S., S.D., S.O.-G., E.C.L., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
C P Derdeyn - Department of Radiology (S.O.-G., C.P.D., G.B., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
G Bathla - Department of Radiology (S.O.-G., C.P.D., G.B., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
D M Hasan - Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
E A Samaniego - Department of Radiology (S.O.-G., C.P.D., G.B., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
Resource Type: Journal article
Publication Details: American journal of neuroradiology : AJNR, Vol.41(10), pp.1869-1875
DOI: 10.3174/ajnr.A6772
PMID: 32943423
NLM abbreviation: AJNR Am J Neuroradiol
ISSN: 0195-6108
eISSN: 1936-959X
Publisher: United States
Grant note: name: The Bee Foundation - Brain Aneurysm Research Grant; name: 2019 Pilot SVIN Grant
Language: English
Date published: 10/2020
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Epidemiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
Record Identifier: 9984070401202771

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