Spasm of the basilar artery in the dog was induced by the injection of blood into the cisterna magna, and documented by means of vertebral angiography. Reserpine was administered to dogs to inhibit the concentration of catecholamines and serotonin in platelets. It was found that constriction of the basilar artery did not occur when the blood injected into the subrachnoid space was taken from dogs that received reserpine, but did occur when untreated blood was used. It was concluded that serotonin is one of the principal agents in the production of spasm of the basilar artery following subarachnoid hemorrhage. (28:400-404, 1973) The management of patients with ruptured intracranial aneurysms is complicated by an apparently ir¬ reducible and unmanageable mor¬ bidity that can be traced directly to cerebral vasoconstriction and in¬ farction. Because of the threat of vasospasm, surgeons must often defer operation and risk a second hemor¬ rhage. Those who operate early do so with the knowledge that postopera¬ tive infarction may occur. Technical skills required to attack aneurysms successfully have been mastered by many surgeons. Vasospasm, on the other hand, remains a challenge and has yet to respond to any practical modality of treatment.Echlin1 was the first to demonstrate that the application of blood against the walls of large cerebral arteries of experimental animals would produce vasoconstriction; this phenomenon has been confirmed in dogs,26 cats,7·8 and monkeys.915 The common denom¬ inator of all these studies has been the physical contact in the subarach¬ noid space of blood with the adventitia of the vessel under study. After a series of studies of the various frac¬ tions of blood, Kapp et al7 concluded that the platelet fraction carried the predominant vasoconstriction ele¬ ments. In humans, serotonin16-24 is one of the principal agents -along with catecholamines,23·25 prostaglandians,26 and histamines17,22,23 stored by platelets.The application of serotonin to cere¬ bral vessels either topically7·9·27 or intra-arterially3·28 will cause marked arterial constriction. Reserpine, a phosphodiesterase inhibitor,29 is known to prevent the storage of serotonin19,22·30"32 and other vasoactive amines22·25 in platelets. This ac¬ tion is prolonged and may reduce ser¬ otonin content for up to a week. 33 We shall describe the modification of experimental hemorrhagic cerebral vasospasm by the administration of reserpine to deplete platelets of sero¬ tonin as well as other platelet-stored vasoactive amines such as histamine, levarterenol, and epinephrine.
MethodArterial spasm was produced in dogs using a method previously described by us. Autologous or homologous blood was in¬ jected into the cisterna magna under di¬ rect vision using microsurgical technique, and the diameter of the basilar artery was ascertained through serial vertebral angi¬ ography. Thirty mongrel dogs, weighing between 7 and 18 kg, were used. These were divided into four groups as follows: group A: normal dog receiving autologous untreated arterial...