1029SUMMARY The potential efficacy of the calcium channel blocker verapamil in modifying ischemic brain injury was evaluated in anesthetized rats subjected to 60 or 90 min of diffuse forebrain ischemia produced by bilateral occlusion of the carotid and vertebral arteries. Treated animals received verapamil, 2 mg/kg intravenously, prior to ischemia. Four hours of postischemic recirculation was permitted by reversing the carotid occlusions. Intermittent high-voltage slow-wave activity was noted on electroencephalograms shortly after verapamil infusion, prior to ischemia. The ischemic insult induced an isoelectric EEG, which tended to persist during recirculation in both treated and untreated animals. Similarly, verapamil pretreatment failed to influence brain water content or cerebral energy metabolites (phosphocreatine, ATP, ADP, AMP) or cerebral energy charge when assayed after four hours of recirculation. Thus, verapamil failed to confer a protective effect on brain electrical activity, water content, or energy metabolites following ischemia in this model. Stroke Vol 15, No 6, 1984 CONSIDERABLE RECENT ATTENTION has been devoted to the role of perturbed calcium ion homeostasis in contributing to hypoxic-ischemic cellular injury.1 ' 2 Normally, intracellular calcium ion activity is regulated at a level several orders of magnitude less than that of the extracellular space.3 During cerebral ischemia, extracellular calcium ion activity has been shown to decline at cerebral blood flows below 6-9 ml/ 100 g/min, concomitant with membrane depolarization as signalled by rising extracellular potassium ion activity, 4 suggesting that the opening of voltage-dependent calcium ion channels within the plasma membrane has permitted the intracellular influx of this ion.
1In addition, the energy failure of ischemia results in a release of calcium from its normal ATP-dependent sites of sequestration in the endoplasmic reticulum. 5 Finally, ischemia impairs the ability of mitochondria to accumulate calcium. 6 The resulting increase in free cytoplasmic calcium activity disrupts a variety of cellular functions 6 and, in particular, may be responsible in part for the breakdown of membrane phospholipids and massive release of free fatty acids due to stimulation of phospholipases.1 ' 7i 8 The latter events, in turn, have been implicated in contributing to irreversible cellular injury.A deleterious effect of the intracellular influx of calcium is strongly suggested by recent studies in extracerebral tissue. Schanne et al 9 reported that hepatocytes cultured in a calcium-depleted medium were able to withstand exposure to a variety of otherwise noxious membrane-active toxins. Farber and colleagues demonstrated that survival of heart and liver cells following prolonged ischemia is markedly improved by blocking calcium influx with chlorpromazine.7 Calcium channel blockers, including verapamil, have been demonstrated to preserve myocardial function in the face of ischemic injury.1(M2 In isolated rat hearts subjected to global ischemia, ver...