Ultrahigh-dose intraarterial infusion of verapamil through an indwelling microcatheter for medically refractory severe vasospasm: initial experience

被引:42
作者
Albanese, Erminia [1 ]
Russo, Antonino [1 ]
Quiroga, Monica [1 ]
Willis, Rhett N., Jr. [1 ]
Mericle, Robert A. [2 ]
Ulm, Arthur J. [1 ,3 ]
机构
[1] Mercer Univ, Sch Med, Georgia Neurosurg Inst, Macon, GA 31201 USA
[2] Vanderbilt Univ, Med Ctr, Dept Neurol Surg, Nashville, TN USA
[3] Louisiana State Univ, Dept Neurosurg, New Orleans, LA USA
关键词
cerebral vasospasm; endovascular therapy; verapamil; ANEURYSMAL SUBARACHNOID HEMORRHAGE; CEREBRAL-BLOOD-FLOW; INTRACRANIAL-PRESSURE CHANGES; INTRACORONARY VERAPAMIL; PENETRATING ARTERIOLES; CALCIUM-ANTAGONISTS; BALLOON ANGIOPLASTY; NIMODIPINE; PAPAVERINE; THERAPY;
D O I
10.3171/2009.9.JNS0997
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Vasospasm is one of the leading causes of morbidity and death following aneurysmal subarachnoid hemorrhage (SAH). Many patients suffer devastating strokes despite the best medical therapy. Endovascular treatment is the last line of defense for cases of medically refractory vasospasm. The authors present a series of patients who were treated with a prolonged intraarterial infusion of verapamil through an in-dwelling microcatheter. Methods. Over a 1-year period 12 patients with medically refractory vasospasm due to aneurysmal SAH were identified. Data were retrospectively collected, including age, sex, Hunt and Hess grade, Fisher grade, aneurysm location, aneurysm treatment, day of the onset of vasospasm, intracranial pressure, mean arterial pressures, intraarterial treatment of vasospasm, dosages and times of verapamil infusion, presence of a new ischemic area on CT scan, modified Rankin scale score at discharge and at the last clinical follow-up, and discharge status. Results. Twenty-seven treatments were administered. Between 25 and 360 mg of verapamil was infused per vessel (average dose per vessel 164.6 mg, range of total dose per treatment 70-720 mg). Infusion times ranged from 1 to 20.5 hours (average 7.8 hours). The number of treated vessels ranged from 1 to 7 per patient. The number of treatments per patients ranged from 1 to 4. There was no treatment-related morbidity or death. Blood pressure and intracranial pressure changes were transient and rapidly reversible. Among the 36 treated vessels, prolonged verapamil infusion was completely effective in 32 cases and partially effective in 4. Only 4 vessels required angioplasty for refractory vasospasm after prolonged verapamil infusion. There was no CT scanning evidence of new ischemic events in 9 of the 12 patients treated. At last clinical follow-up 6-12 months after discharge, 8 of 11 patients had a modified Rankin Scale score <= 2. Conclusions. Prolonged intraarterial infusion of verapamil is a safe and effective treatment for medically refractory severe vasospasm and reduces the need for angioplasty in such cases. (DOI: 10.3171/2009.9.JNS0997)
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页码:913 / 922
页数:10
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