Abstract Details

Title Analyzing the Neurophysiologic Effects of IA Verapamil During Angiographic Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Topic Neuro Trauma and Critical Care

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-005

Objective To characterize EEG responses to intra-arterial verapamil administration during angiographic treatment of cerebral vasospasm in aneurysmal subarachnoid hemorrhage patients.

Background Intra-arterial vasodilators like verapamil are commonly used to treat symptomatic cerebral vasospasm in aneurysmal subarachnoid hemorrhage (aSAH). However, their neurophysiologic effects remain poorly understood. Continuous EEG has the potential to study these effects and evaluate individual treatment responses following drug administration. While case studies have reported postprocedural improvements in EEG parameters associated with delayed cerebral ischemia (e.g. Claassen et al., 2004), studies on larger cohorts are lacking.

Design/Methods We retrospectively identified aSAH patients admitted to our Neurointensive Care Unit between 2015 and 2023 who underwent angiographic treatment for cerebral vasospasm with administration of intra-arterial verapamil. Following EEG artifact reduction and feature extraction, we computed mean band powers, alpha-delta ratio (ADR), and relative alpha variability (RAV) across four time intervals: a 6-hour baseline following admission and 3 periprocedural intervals (12 to 6 hours before procedure start, 6 to 0 hours before procedure start, and 0 to 6 hours after procedure finish). Means were compared via repeated measures ANOVAs and pairwise comparisons with Bonferroni correction.

Results 24 patients (mean age 55.2 ± 12.0, 79.2% women, Hunt Hess 3.5 ± 0.9, modified Fisher 3.8 ± 0.4) underwent 48 angiograms with verapamil administration (mean dose 26.0 ± 11.3 mg, 8.9 ± 2.6 days after bleed, 16.7% with angioplasty). Patients showed significant decreases in beta power and ADR (p < 0.01) from baseline to the periprocedural time intervals. However, no mean differences were seen across power bands, ADR, or RAV values between the three periprocedural time intervals.

Conclusions Early analysis does not show clear group-level differences in qEEG parameters when comparing six-hour intervals pre vs post intra-arterial verapamil administration. Further analyses will explore whether modeling trajectories or accounting for individual variability provides greater insight.

Authors/Disclosures
Rafael Maarek PRESENTER	Mr. Maarek has received research support from National Heart Lung & Blood Institute. Mr. Maarek has received research support from Richard K. Gershon Endowed Medical Student Research Fellowship.
Kaitlyn Stoehr, MS5	Ms. Stoehr has nothing to disclose.
Sithmi M. Jayasundara	Miss Jayasundara has nothing to disclose.
David J. Vargas Estrella	Mr. Vargas Estrella has nothing to disclose.
Rachel S. Choi (Yale School of Medicine)	Ms. Choi has nothing to disclose.
Amedeo Rapuano (Yale New Haven Hospital)	Amedeo Rapuano has nothing to disclose.
Andrew B. Koo, MD	Dr. Koo has nothing to disclose.
Yilun Chen (Yale University)	Ms. Chen has nothing to disclose.
Jessica Magid-Bernstein, MD, PhD (Yale School of Medicine)	Dr. Magid-Bernstein has nothing to disclose.
Lena O'Keefe, MD	Dr. O'Keefe has nothing to disclose.
Ryan Hebert	Ryan Hebert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus .
Farhad Bahrassa (Yale Department of Neurosurgery)	Farhad Bahrassa has nothing to disclose.
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.

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