High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage
High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage
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DOI：
10.3171/jns/2008/108/3/0458
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发表时间：
2008-03-01
影响因子：
4.1
通讯作者：
Chao, Kuo H.
中科院分区：
文献类型：
--
作者：
Keuwamp, Janine;Murali, Raj;Chao, Kuo H.
Object.由于口服钙通道阻滞剂似乎可以减轻蛛网膜下腔出血（SAH）后脑血管痉挛的严重程度，因此在非侵入性缓解血管痉挛方法不成功的病例中，动脉内应用钙通道阻滞剂的兴趣已经出现。由于担心血流动力学稳定性和颅内压变化，迄今为止的研究仅限于低动脉内剂量给药。这些剂量虽然对轻度血管痉挛有效，但在严重病例中是不够的。作者介绍了一组10例脑血管痉挛患者，他们接受了12次手术，每次手术动脉内注射≥ 20 mg维拉帕米。由资深作者对2005年2月至2006年10月期间因蛛网膜下腔出血（SAH）而接受脑血管痉挛血管内治疗的所有患者进行了回顾性审查。确定了10名患者，他们总共经历了12次手术，在此期间动脉内给予了≥ 20 mg维拉帕米。根据血管造影报告、麻醉记录和护理记录，我们获得了维拉帕米治疗前后的平均动脉压（MABP）、心率、颅内压（ICP）（如果有的话）和血管痉挛程度的可见变化。动脉内给予≥ 20 mg维拉帕米后，未观察到MABP、心率或ICP的统计学显著变化，根据我们的分级系统，血管痉挛的改善程度具有统计学显著性。血流动力学参数的变化与维拉帕米的总剂量无关。本研究表明，大剂量维拉帕米动脉内注射可用于治疗脑血管痉挛，而不影响血流动力学稳定性或增加颅内压。
Object. Because oral calcium channel blockers appear to reduce the severity of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH), interest in their application intraarterially has emerged for cases in which noninvasive means of alleviating vasospasm are unsuccessful. Studies to date have been limited to the administration of low intraarterial doses because of concerns about hemodynamic stability and changes in intracranial pressure. These doses, although effective in cases of milder vasospasm, were inadequate in severe cases. The authors present a series of 10 patients with cerebral vasospasm who underwent 12 procedures in which they received >= 20 mg of intraarterial verapamil per procedure.Methods. A retrospective review was undertaken of all patients who underwent endovascular treatment for cerebral vasospasm due to aneurysmal SAH by the senior author between February 2005 and October 2006. Ten patients were identified who had undergone a total of 12 procedures during which >= 20 mg of intraarterial verapamil had been administered. From angiography reports, anesthesia records, and nursing records, we obtained pre- and postverapamil mean arterial blood pressures (MABPs), heart rates, intracranial pressures (ICPs) (when available), and visible changes in the degree of vasospasm.Results. No statistically significant changes in MABP, heart rate, or ICP were observed after administration of >= 20 mg of intraarterial verapamil, and the degree of improvement in vasospasm was statistically significant based on our grading system. No correlation was found between the change in hemodynamic parameters and the total dose of verapamil.Conclusions. This study indicates that-high-dose intraarterial verapamil may be used to treat cerebral vasospasm without compromising hemodynamic stability or increasing ICP.