Article Figures & Data
Figures
- Fig 1.
Frontal projection angiograms of the right internal carotid artery.
A, Before treatment with verapamil. Before verapamil infusion, moderately severe vasospasm can be seen in the right anterior cerebral, middle cerebral, and distal internal carotid arteries. Better and more rapid opacification of the right posterior cerebral artery through the right posterior communicating artery can be seen, suggesting high resistance in the anterior circulation.
B, After treatment with verapamil. The diameters of the right distal internal carotid artery, right M1 section, and right A1 section increase by 6%, 12%, and 68%, respectively. Normal opacification of the right middle and anterior cerebral arteries is restored, even though there is no significant change of the diameters of the distal internal carotid and right middle cerebral arteries.
Tables
Patient Age (y) Sex H&H Aneurysm Treatment Vasospasm HHH Post-treatment Examination(*) 1 58 F III Left PCOM Clipped Mild No Better 2 56 F III Right SCA, vermian AVM NBCA glued Moderate Yes Unchanged 3 60 F I ACOM Clipped Mild Yes Better 4†‡ 63 F III Right MCA Clipped Mild No Unchanged 4†‡ 63 F III Right MCA Clipped Mild Yes Better 5 48 F IV Basilar Coiled Moderate No Better 6 51 F V ACOM Clipped Severe Yes Worse 7 39 F I Right PCOM Clipped Moderate Yes Unchanged 8 65 F III Right ACOM Clipped Mild No Unchanged 9‡ 39 F I Basilar Failed clipping and coiling Severe No Worse 10 53 M III Right vertebral dissection Coiled Severe Yes Unchanged 11 45 F V ACOM Clipped Severe Yes Unchanged 11† 45 F V ACOM Clipped Severe Yes Unchanged 12‡ 41 F V ACOM Coiled Severe No Unchanged 12†‡ 41 F V ACOM Coiled Severe No Better 13‡ 60 M I Left MCA Clipped Severe Yes Better 14 65 F III ACOM Clipped Mild Yes Better 15‡ 17 F III Left ACOM Clipped Moderate No Unchanged 16‡ 60 F III Basilar Clipped Severe No Unchanged 17‡ 43 M III Basilar Clipped Moderate Yes Unknown 18 42 F V Left MCA Clipped Severe Yes Unchanged 19‡ 48 F V Left PICA Coiled Severe Yes Unchanged 20 78 F III Left PICA Coiled Mild Yes Unknown 21 69 F IV ACOM Clipped Moderate Yes Unchanged 22 56 F IV Left MCA Clipped Mild Yes Unchanged 22† 56 F IV Left MCA Clipped Mild Yes Unchanged 23 47 F I Basilar,bilateral MCA Clipped Severe No Worse 23† 47 F I Basilar,bilateral MCA Clipped Severe Yes Better 24 69 M III Right MCA Clipped Moderate No Unchanged 25 39 M III Right MCA Clipped Mild Yes Unchanged 26 69 F III Left choroidal, bilateral MCA L choroidal clipped, L MCA wrapped Moderate Yes Unchanged 27‡ 65 M IV ACOM Clipped Mild Yes Better 28 63 M V ACOM Clipped Severe No Unknown 29 58 M IV Left SCA Clipped Moderate Yes Better Note.—H&H indicates Hunt and Hess grade; HHH, hypertension, hypervolemia, and hemodilution treatment; F, female, M, male; PCOM, posterior communicating artery; SCA, subclavian artery; AVM, arteriovenous malformation; ACOM, anterior communicating artery; MCA, middle cerebral artery; PICA, posterior inferior cerebellar artery; NBCA, 𝓃-butyl-cyanoacrylate.
* Post-treatment neurologic examinations were reviewed by an independent stroke neurologist.
† Patients who underwent repeat treatment with verapamil.
‡ Patients who underwent repeat control angiography 10 to 15 minutes after verapamil infusion.
Number of Treatments Dose of Verapamil Percent Change of MAP at 10 Min*; Percent Change of MAP at 20 Min* Percent Change of Heart Rate at 10 Min† Percent Change of Heart Rate at 20 Mi† Not on vasopressor 11 3.4 ± 0.5 mg (51 ± 9 mcg/kg − 3.1 ± 1.5 − 0.6 ± 1.7 2.4 ± 2.3 4.0 ± 2.6 On vasopressor 23 3.0 ± 0.4 (42 ± 6 mcg/kg) − 4.1 ± 1.3 − 2.2 ± 1.4 1.0 ± 1.2 1.0 ± 1.6 Overall 34 3.1 ± 0.3 mg (44 ± 5 mcg/kg) − 3.8 ± 1.0 − 1.7 ± 1.1 1.5 ± 1.1 2.0 ± 1.4 * The baseline mean arterial pressure of these patients was 112 ± 3 mm Hg †(mean ± standard error of the mean).
† The average pretreatment heart rate was 79 ± 3 bpm. (mean ± standard error of the mean).
Clinical Grade (Hunt & Hess) Vasospasm Number of Treatments Neurologic Examination Results Better Unchanged Worse I, II, III Mild 8 3 5 0 Moderate 3 0 3 0 Severe 1 1 0 0 IV, V Mild 3 1 2 0 Moderate 1 0 1 0 Severe 1 0 1 0 Total Mild 12 4 8 0 Moderate 4 0 4 0 Severe 2 1 1 0 Total 17 5 12 0
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