Abstract 47: Use Of Intra-arterial Infusion of Calcium-Channel Blockers Through An Indwelling Microcatheter: One Institution's Experience
INTRODUCTION: Vasospasm following aneurysmal subarachnoid hemorrhage is a very extensively studied source of morbidity and mortality. Numerous treatment regiments have been investigated and published. A recently published article discussed the use of prolonged infusion of verapamil through an indwelling catheter as an effective treatment for medically refractory severe vasospasm. The goal of our study is to report our institution's experience with this method of treatment.
METHODS & MATERIALS: All patients with medically refractory vasospasm from July 2009 through August 2011 were included in the study. A retrospective review of data was compiled. In particular, age, sex, aneurysm location, aneurysm treatment, intra-arterial treatment fo vasospasm, dosages and times of medication infusion, and presence of new ischemia or progression of ischemia on CT scan were investigated.
RESULTS: A total of 13 treatments were administered. Nicardipine was used in two treatments, and verapamil was used in the remaining eleven treatments. The doses of nicardipine were 10mg and 49 mg, and were infused over 20 min and 75 min respectively. The doses of verapamil ranged from 41 mg to 200 mg. One patient was treated with both nicardipine and verapamil at one treatment session. The infusion times ranged from 25 min to 22 hr. Between 1 and 3 vessels were treated per patient resulting in a total of 19 vessels treated. The number of treatments per patient ranged from one to two. Review of pre- and post-treatment CT scans revealed worsening of ischemic changes in 9 of the 13 treatments, while the remaining 4 treatments showed no change or progression of ischemic changes on imaging. One patient had a conversion to a hemorrhagic infarct from an inschemic infarct after a treatment.
CONCLUSIONS: Upon reviewing our data we have come to the conclusion that prolonged infusion of calcium channel blockers is not an effective treatment for medically refractory severe vasospasm. After 13 treatments we have decided to not continue with this treatment. Therefore, we believe that angioplasty is still the gold standard for treatment of medically refractory vasospasm.
- © 2012 by American Heart Association, Inc.