The clinical impact and safety profile of high-dose intra-arterial verapamil treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Aneurysm, Ruptured
/ complications
Anticonvulsants
/ therapeutic use
Brain Ischemia
/ prevention & control
Dose-Response Relationship, Drug
Female
Functional Status
Humans
Infusions, Intra-Arterial
Intracranial Aneurysm
/ complications
Lorazepam
/ therapeutic use
Male
Retrospective Studies
Seizures
/ chemically induced
Subarachnoid Hemorrhage
/ complications
Treatment Outcome
Vasodilator Agents
/ administration & dosage
Vasospasm, Intracranial
/ drug therapy
Verapamil
/ administration & dosage
Cerebral vasospasm
Delayed cerebral ischemia
Efficacy
Intra-arterial verapamil
Safety
Journal
Clinical neurology and neurosurgery
ISSN: 1872-6968
Titre abrégé: Clin Neurol Neurosurg
Pays: Netherlands
ID NLM: 7502039
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
31
12
2020
revised:
01
02
2021
accepted:
02
02
2021
pubmed:
16
2
2021
medline:
4
1
2022
entrez:
15
2
2021
Statut:
ppublish
Résumé
Cerebral vasospasm (CVS) leads to delayed cerebral ischemia (DCI) and cerebral infarction, a potential cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to evaluate the clinical efficacy and safety profile of high-dose IA verapamil for aSAH in a large series of patients. Between 2011-2019, a retrospective cohort of 188 consecutive patients presenting with aSAH were reviewed. High-dose IA verapamil (> 20 mg per vascular territory on each side) was intermittently used for appropriate patients to manage symptomatic CVS. Of the 188 patients reviewed, 86 were treated with high-dose IA verapamil. The clinical efficacy and safety profile of our ruptured aneurysm patient cohort were compared to historical literature controls. The primary endpoints studied included radiographic stroke corresponding to cerebral vasospasm, clinical outcome at discharge and subsequent follow-up, and overall functional status as defined by the modified Rankin scale (mRS). The safety profile of high dose IA verapamil was a secondary endpoint. IA verapamil was delivered between 2-16 days after ictus (median post-bleed day 6) and 74 % of patients had documented clinical improvement after therapy, with 61.5 % achieving good functional outcomes (mRS < 2). 25.5 % of all patients had evidence of vasospasm-related DCI. 3 patients sustained transient hemodynamic changes after verapamil treatment and 10 patients developed post-procedural seizures successfully managed with intravenous lorazepam. High-dose IA verapamil treatment is well-tolerated in the high-risk aneurysmal subarachnoid hemorrhage population that experience severe, symptomatic CVS with good functional outcomes at follow-up.
Sections du résumé
BACKGROUND
BACKGROUND
Cerebral vasospasm (CVS) leads to delayed cerebral ischemia (DCI) and cerebral infarction, a potential cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to evaluate the clinical efficacy and safety profile of high-dose IA verapamil for aSAH in a large series of patients.
METHODS
METHODS
Between 2011-2019, a retrospective cohort of 188 consecutive patients presenting with aSAH were reviewed. High-dose IA verapamil (> 20 mg per vascular territory on each side) was intermittently used for appropriate patients to manage symptomatic CVS. Of the 188 patients reviewed, 86 were treated with high-dose IA verapamil. The clinical efficacy and safety profile of our ruptured aneurysm patient cohort were compared to historical literature controls. The primary endpoints studied included radiographic stroke corresponding to cerebral vasospasm, clinical outcome at discharge and subsequent follow-up, and overall functional status as defined by the modified Rankin scale (mRS). The safety profile of high dose IA verapamil was a secondary endpoint.
RESULTS
RESULTS
IA verapamil was delivered between 2-16 days after ictus (median post-bleed day 6) and 74 % of patients had documented clinical improvement after therapy, with 61.5 % achieving good functional outcomes (mRS < 2). 25.5 % of all patients had evidence of vasospasm-related DCI. 3 patients sustained transient hemodynamic changes after verapamil treatment and 10 patients developed post-procedural seizures successfully managed with intravenous lorazepam.
CONCLUSION
CONCLUSIONS
High-dose IA verapamil treatment is well-tolerated in the high-risk aneurysmal subarachnoid hemorrhage population that experience severe, symptomatic CVS with good functional outcomes at follow-up.
Identifiants
pubmed: 33588359
pii: S0303-8467(21)00073-1
doi: 10.1016/j.clineuro.2021.106546
pii:
doi:
Substances chimiques
Anticonvulsants
0
Vasodilator Agents
0
Verapamil
CJ0O37KU29
Lorazepam
O26FZP769L
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106546Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.