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

Abstract

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.

Improvement in Angiographic Cerebral Vasospasm after Intra-Arterial Verapamil Administration

“…It has been suggested by others that distal vessels are more affected by medication infusion than proximal vessels. 7,10 In this study, the effects of intra-arterial verapamil were not different between proximal and distal arterial segments. As shown in Fig 1, intra-arterial vasodilator infusion has the benefit of simultaneous treatment of an entire arterial distribution, including distal vessels not accessible by angioplasty.…”

“…Other studies have reported changes in gross neurologic status in treated patients. [7][8][9][10]17 Those parameters were outside the scope of the current study. In the absence of a control patient population, those data may be of limited value.…”

“…6 Preliminary studies of the effects of intra-arterial verapamil on angiographic vasospasm have yielded mixed and often poorly quantified results. [7][8][9][10] In 1 quantitative case series by Mazumdar et al 9 using blinded reviewers, there was no statistically significant change in the diameters of vasospastic cerebral arteries after treatment. Three other case series reported increased diameters of treated vasospastic arteries, but these studies did not use blinded reviewers.…”

“…8 Another study reported only binary results in which angiographic vasospasm was described as Ͼ50% before treatment in all cases, and treatment resulting in residual vasospasm of any degree Ͻ50% was reported as "completely effective." 10 The diagnostic method of grading angiographic vasospasm by eye has been found to be unreliable, and clear-cut definitions of vessel stenosis are essential. 11 Bias in the data can be decreased by use of blinded reviewers.…”

Intra-arterial verapamil post-thrombectomy is feasible, safe, and neuroprotective in stroke

“…36 Verapamil is an L-type calcium-channel blocker (CCB) currently used clinically for intra-arterial administration in the treatment of cerebral vasospasm with minimal adverse effects. [37][38][39] Previous studies also support a possible therapeutic role for CCBs in stroke neuroprotection. 15,16 Flunarizine, another calcium channel blocker, showed promise in early animal data and clinical application, but failed in the double-blind Flunarizine in Stroke Trial (FIST) of 331 subjects to show clinical benefit; however, mean time interval to treatment was 13.5 h, and subjects did not undergo thrombolysis as part of the protocol.…”