Advertisement

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

  • K. G. Mikeladze
  • D. N. Okishev
  • O. B. Belousova
  • A. N. Konovalov
  • Yu. V. Pilipenko
  • I. S. Ageev
  • A. N. Kaftanov
  • O. D. Shekhtman
  • N. V. Kurdyumova
  • T. F. Tabasaransky
  • E. A. Okisheva
  • S. S. Eliava
  • S. B. Yakovlev
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 127)

Abstract

From 2013 to 2017, at the Burdenko Institute of Neurosurgery, intra-arterial verapamil for treatment of cerebral vasospasm following intracranial hemorrhage after aneurysm rupture was administered to 35 patients (total 75 procedures). The age is from 8 to 77 years. All ruptured aneurysms were treated: in 26 cases with open approach—clipping—and in 9 cases with endovascular occlusion. The procedure was carried out from 0 to 11 days after the operation. Severity of spasm was assessed by angiography and TCDU. Efficacy of the administration was assessed by TCDU 1 h after the procedure and by clinical evaluation of the patient’s condition. The dose of verapamil was 15–50 mg (on average 40 mg) per procedure/per carotid pool and depended on the data of TCDU and clinical and radiological picture. The procedure was performed repeatedly (1–5 times) according to the indications and depending on the patient’s condition, with an interval of 24 h. The procedure was effective as a preventive measure for care of patients in the initial stage of cerebral ischemia and was ineffective with a formed focus of ischemia. Endovascular administration of verapamil for treatment of cerebral vasospasm is a safe technique which positively affects the overall recovery of such patients.

Keywords

Intracranial aneurysm Cerebral angiospasm Verapamil Subarachnoid hemorrhage Intra-arterial administration of verapamil 

Notes

Conflict of Interest

The authors declare that they have no conflict of interests.

References

  1. 1.
    Kassell NF, Torner JC, Haley EC, Jane JA, Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg. 1990;73(1):18–36.CrossRefGoogle Scholar
  2. 2.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.CrossRefGoogle Scholar
  3. 3.
    Steiner T, Juvela S, Unterberg A. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93–112.CrossRefGoogle Scholar
  4. 4.
    Muller HR, CHR B, Radü EW, Buser M. Sex and side differences of cerebral arterial caliber. Neuroradiology. 1991;33(3):212–6.CrossRefGoogle Scholar
  5. 5.
    Smoker WRK, Price MJ, Keyes WD, Corbett JJ, Gentry LR. High-resolution computed tomography of the basilar artery: 1. Normal size and position. Am J Neuroradiol. 1986;7(1):55–60.PubMedGoogle Scholar
  6. 6.
    Jun P, Ko NU, English JD, Dowd CF, Halbach VV, Higashida RT, Lawton MT, Hetts SW. Endovascular treatment of medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Am J Neuroradiol. 2010;31(10):1911–6.CrossRefGoogle Scholar
  7. 7.
    Eskridge JM, Song JK. A practical approach to the treatment of vasospasm. Am J Neuroradiol. 1997;18(9):1653–60.PubMedGoogle Scholar
  8. 8.
    Higashida RT, Halbach VV, Dowd CF, Dormandy B, Bell J, Hieshima GB. Intravascular balloon dilatation therapy for intracranial arterial vasospasm: patient selection, technique, and clinical results. Neurosurg Rev. 1992;15(2):89–95.CrossRefGoogle Scholar
  9. 9.
    Sayama CM, Liu JK, Couldwell WT. Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 2006;21(3):E12.CrossRefGoogle Scholar
  10. 10.
    Харкевич ДА. Фармакология - 10-е изд. Москва: ГЭОТАР-Медиа; 2010.Google Scholar
  11. 11.
    Dominic JA, Bourne DW, Tan TG, Kirsten EB, McAllister RG Jr. The pharmacology of verapamil. III. Pharmacokinetics in normal subjects after intravenous drug administration. J Cardiovasc Pharmacol. 1981;3(1):25–38.CrossRefGoogle Scholar
  12. 12.
    Shimizu K, Ohta T, Toda N. Evidence for greater susceptibility of isolated dog cerebral arteries to Ca antagonists than peripheral arteries. Stroke. 1980;11(3):261–6.CrossRefGoogle Scholar
  13. 13.
    Takayasu M, Bassett JE, Dacey RG Jr. Effects of calcium antagonists on intracerebral penetrating arterioles in rats. J Neurosurg. 1988;69(1):104–9.CrossRefGoogle Scholar
  14. 14.
    Messing M, Essen H, van Smith TL, Smits JFM, Struyker-Boudierb HAJ. Microvascular actions of calcium channel antagonists. Eur J Pharmacol. 1991;198(2–3):189–95.CrossRefGoogle Scholar
  15. 15.
    Babbitt DG, Perry JM, Forman MB. Intracoronary verapamil for reversal of refractory coronary vasospasm during percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 1988;12(5):1377–81.CrossRefGoogle Scholar
  16. 16.
    Vijayalakshmi K, Whittaker VJ, Kunadian B, Graham J, Wright RA, Hall JA, Sutton A, de Belder MA. Prospective, randomised, controlled trial to study the effect of intracoronary injection of verapamil and adenosine on coronary blood flow during percutaneous coronary intervention in patients with acute coronary syndromes. Heart. 2006;92(9):1278–84.CrossRefGoogle Scholar
  17. 17.
    Joshi S, Young WL, Pile-Spellman J, Duong DH, Hacein-Bey L, Vang MC, Marshall RS, Ostapkovich N, Jackson T. Manipulation of cerebrovascular resistance during internal carotid artery occlusion by intraarterial verapamil. Anesth Analg. 1997;85(4):753–9.CrossRefGoogle Scholar
  18. 18.
    Feng L, Fitzsimmons B-F, Young WL, Berman MF, Lin E, Aagaard BDL, Duong H, Pile-Spellman J. Intraarterially administered verapamil as adjunct therapy for cerebral vasospasm: safety and 2-year experience. Am J Neuroradiol. 2002;23(8):1284–90.PubMedGoogle Scholar
  19. 19.
    Albanese E, Russo A, Quiroga M, Willis RN Jr, Mericle RA, Ulm AJ. Ultrahigh-dose intraarterial infusion of verapamil through an indwelling microcatheter for medically refractory severe vasospasm: initial experience. Clinical article. J Neurosurg. 2010;113(4):913–22.CrossRefGoogle Scholar
  20. 20.
    Keuskamp J, Murali R, Chao KH. High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2008;108(3):458–63.CrossRefGoogle Scholar
  21. 21.
    Sehy JV, Holloway WE, Lin S-P, Cross DT, Derdeyn CP, Moran CJ. Improvement in angiographic cerebral vasospasm after intra-arterial verapamil administration. Am J Neuroradiol. 2010;31(10):1923–8.CrossRefGoogle Scholar
  22. 22.
    Mazumdar A, Rivet DJ, Derdeyn CP, Cross DT, Moran CJ. Effect of intraarterial verapamil on the diameter of vasospastic intracranial arteries in patients with cerebral vasospasm. Neurosurg Focus. 2006;21(3):E15.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • K. G. Mikeladze
    • 1
  • D. N. Okishev
    • 1
  • O. B. Belousova
    • 1
  • A. N. Konovalov
    • 1
  • Yu. V. Pilipenko
    • 1
  • I. S. Ageev
    • 1
  • A. N. Kaftanov
    • 1
  • O. D. Shekhtman
    • 1
  • N. V. Kurdyumova
    • 1
  • T. F. Tabasaransky
    • 1
  • E. A. Okisheva
    • 1
  • S. S. Eliava
    • 1
  • S. B. Yakovlev
    • 1
  1. 1.Burdenko Institute of NeurosurgeryMoscowRussia

Personalised recommendations