Abstract Details

Title Increase in Quantitative CBF with Intra-Arterial Verapamil Treatment for Refractory Vasospasm after SAH

Topic Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 084

Objective

Background BACKGROUND: Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains a major cause of death and disability. Delayed cerebral ischemia (DCI) after SAH is likely multi-factorial, eventually leading to altered CBF and cerebral infarction. Neurointerventional treatment with IA verapamil is commonly used for medically refractory vasospasm, but with limited efficacy data on CBF, clinical, and DCI outcomes.

Design/Methods DESIGN/METHODS: Regional CBF was measured using two sodium iodide scintillation scalp detectors approximating the cortical vascular territory of the treated vessel. A 1.0 mL saline bolus of 1-2 mCi of 133-Xe was injected through the coaxial catheter immediately before and after endovascular treatment. Tracer washout was recorded under stable physiologic conditions for 1.5 minutes. CBF was calculated using the initial slope index, the monoexponential slope of tracer washout from 20-80 seconds after isotope injection. Data were analyzed including standard corrections for remaining activity and physiologic parameters (Cortexplorer CBF2A, Ceretronix, Denmark). Mean arterial blood pressure, PaCO2, serum hemoglobin, and delivery of anesthetic agents were monitored. Change in CBF expressed as a mean ± standard deviation was calculated using paired t-test.

Results RESULTS: A total of 20 SAH patients with refractory vasospasm were studied. Moderate to severe angiographic spasm was reported in 82% of subjects. Sixteen (80%) subjects were treated with only IA verapamil and 3 (15%) subjects were treated with additional angioplasty. Mean change in regional CBF was 9 ± 11 ml/100gm/min (p=0.005).

Conclusions CONCLUSIONS: In our prospective study of 20 patients with IA verapamil treatment for refractory vasospasm, we detected a mean change of 23% in quantitative CBF using the intra-arterial 133-Xe washout method. Without significant radiographic evidence of large vessel change at the time of measurement, increases in CBF may be related to microcirculatory effects of IA verapamil treatment.

Authors/Disclosures
Keiko A. Fukuda, MD (UPMC Department of Neurology) PRESENTER	Dr. Fukuda has nothing to disclose.
	No disclosure on file
Michael Lawton, MD (University of California, San Francisco)	No disclosure on file
John E. Greenlee, MD, FAAN (University of Utah)	Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Zeigler Cohen Roche. Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Sommers Schwartz PC. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for St Francis Hospital. Dr. Greenlee has received publishing royalties from a publication relating to health care. Dr. Greenlee has received publishing royalties from a publication relating to health care.
Wade S. Smith, MD, PhD (University of California, San Francisco)	Dr. Smith has stock in MindRhythm, Inc. The institution of Dr. Smith has received research support from NIH. Dr. Smith has received intellectual property interests from a discovery or technology relating to health care. Dr. Smith has received publishing royalties from a publication relating to health care.
Jan N. Lycke, MD	Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene. Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Lycke has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Lycke has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Lycke has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GeNeuro. The institution of Dr. Lycke has received research support from Sanofi.
	No disclosure on file
Walter D. Obrist, PhD (University of Pittsburgh, Dept of Neuroscience)	No disclosure on file
Nerissa U. Ko, MD (UCSF Neurovascular Service)	The institution of Dr. Ko has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Route 92, Inc. The institution of Dr. Ko has received research support from American Heart Association. The institution of Dr. Ko has received research support from NIH. The institution of Dr. Ko has received research support from NIH.

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