Intra-arterial Administration of Verapamil for the Prevention and Treatment of Cerebral Angiospasm

Mikeladze, K G; Okishev, D N; Белоусова, О Б; Konovalov, A N; Pilipenko, Yu V; Ageev, I S; Kaftanov, A N; Shekhtman, O D; Kurdyumova, N V; Tabasaransky, T F; Окишева, Е. А.; Eliava, Sh Sh; Yakovlev, S B

doi:10.1007/978-3-030-04615-6_28

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…A recent systematic review highlighted that there are no randomized trials to support the routine use of verapamil in vasospasm and DCI, although observational data suggest possible clinical but underestimated benefits [ 22 ]. On a cohort series of 75 procedures from Burdenko Institute of Neurosurgery, intra-arterial verapamil proved to be effective in patients in the initial stage of DCI [ 23 ]. Similar results were reported by Mao and co-workers [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Verapamil has been reported to be the most common first-line therapy against aneurysmal SAH-associated vasospasm and DCI in the United States [ 25 ]. It has mainly been used intra-arterially in high doses [ 23 , 26 , 27 ]. Notably, it has not been shown to compromise hemodynamic stability, although data on increased intracranial pressure are conflicting [ 26 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

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Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Luzzi,

Bektaşoğlu,

Doğruel

et al. 2024

Neurosurg Rev

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The clinical management of aneurysmal subarachnoid hemorrhage (SAH)-associated vasospasm remains a challenge in neurosurgical practice, with its prevention and treatment having a major impact on neurological outcome. While considered a mainstay, nimodipine is burdened by some non-negligible limitations that make it still a suboptimal candidate of pharmacotherapy for SAH. This narrative review aims to provide an update on the pharmacodynamics, pharmacokinetics, overall evidence, and strength of recommendation of nimodipine alternative drugs for aneurysmal SAH-associated vasospasm and delayed cerebral ischemia. A PRISMA literature search was performed in the PubMed/Medline, Web of Science, ClinicalTrials.gov, and PubChem databases using a combination of the MeSH terms “medical therapy,” “management,” “cerebral vasospasm,” “subarachnoid hemorrhage,” and “delayed cerebral ischemia.” Collected articles were reviewed for typology and relevance prior to final inclusion. A total of 346 articles were initially collected. The identification, screening, eligibility, and inclusion process resulted in the selection of 59 studies. Nicardipine and cilostazol, which have longer half-lives than nimodipine, had robust evidence of efficacy and safety. Eicosapentaenoic acid, dapsone and clazosentan showed a good balance between effectiveness and favorable pharmacokinetics. Combinations between different drug classes have been studied to a very limited extent. Nicardipine, cilostazol, Rho-kinase inhibitors, and clazosentan proved their better pharmacokinetic profiles compared with nimodipine without prejudice with effective and safe neuroprotective role. However, the number of trials conducted is significantly lower than for nimodipine. Aneurysmal SAH-associated vasospasm remains an area of ongoing preclinical and clinical research where the search for new drugs or associations is critical.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Luzzi,

Bektaşoğlu,

Doğruel

et al. 2024

Neurosurg Rev

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“…Cerebral vasospasm is commonly observed after aneurysmal SAH, 5–9 , 12 after traumatic SAH, or SAH following removal of intracranial tumors. SAH is well described in the literature.…”

Section: Discussionmentioning

confidence: 99%

Treatment of postoperative vasospasm with intraarterial verapamil after removal of intracranial tumor: patient series

Mikeladze¹,

Konovalov²,

Bykanov³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND The authors report on four clinical cases with intraarterial verapamil administration to resolve vasospasm in patients who underwent surgery for intracranial tumors. Iatrogenic subarachnoid hemorrhage after tumor resection and subsequent vasospasm (an increase in the systolic linear velocity of blood flow through the M1 segment of the middle cerebral artery of more than 250 cm/sec; Lindegaard index: 4.1) were observed in four patients during the early postoperative period after the removal of intracerebral tumors. Each vasospasm case was confirmed by angiography data, was clinically significant, and manifested as the development of a neurological deficit. OBSERVATIONS Resolution of vasospasm with the intraarterial administration of verapamil was achieved in all four cases as confirmed by angiographic data in all four cases and complete regression of neurological symptoms in two cases. In all four presented cases, vasospasm was resolved; unfortunately, the resolution did not always lead to significant clinical improvement. However, lethal outcomes were avoided in two cases, and almost full recoveries were achieved in the other two. LESSONS The authors believe that the removal of intracranial tumors can cause expected and potential complications, such as cerebral vasospasm, which must be diagnosed and treated in a timely manner.

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Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm

Woodford

Taylor

Eftekhar

et al. 2022

Interdisciplinary Neurosurgery

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Intra-arterial Administration of Verapamil for the Prevention and Treatment of Cerebral Angiospasm

Cited by 7 publications

References 18 publications

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Beyond nimodipine: advanced neuroprotection strategies for aneurysmal subarachnoid hemorrhage vasospasm and delayed cerebral ischemia

Treatment of postoperative vasospasm with intraarterial verapamil after removal of intracranial tumor: patient series

Dual intra-arterial vasodilators in the management of post-aneurysmal subarachnoid haemorrhage vasospasm

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