Georgia Neurosurgical Institute, Mercer University School of Medicine, Macon, Georgia 31201, USA.
J Neurosurg. 2010 Oct;113(4):913-22. doi: 10.3171/2009.9.JNS0997.
Vasospasm is one of the leading causes of morbidity and death following aneurysmal subarachnoid hemorrhage (SAH). Many patients suffer devastating strokes despite the best medical therapy. Endovascular treatment is the last line of defense for cases of medically refractory vasospasm. The authors present a series of patients who were treated with a prolonged intraarterial infusion of verapamil through an in-dwelling microcatheter.
Over a 1-year period 12 patients with medically refractory vasospasm due to aneurysmal SAH were identified. Data were retrospectively collected, including age, sex, Hunt and Hess grade, Fisher grade, aneurysm location, aneurysm treatment, day of the onset of vasospasm, intracranial pressure, mean arterial pressures, intraarterial treatment of vasospasm, dosages and times of verapamil infusion, presence of a new ischemic area on CT scan, modified Rankin scale score at discharge and at the last clinical follow-up, and discharge status.
Twenty-seven treatments were administered. Between 25 and 360 mg of verapamil was infused per vessel (average dose per vessel 164.6 mg, range of total dose per treatment 70-720 mg). Infusion times ranged from 1 to 20.5 hours (average 7.8 hours). The number of treated vessels ranged from 1 to 7 per patient. The number of treatments per patients ranged from 1 to 4. There was no treatment-related morbidity or death. Blood pressure and intracranial pressure changes were transient and rapidly reversible. Among the 36 treated vessels, prolonged verapamil infusion was completely effective in 32 cases and partially effective in 4. Only 4 vessels required angioplasty for refractory vasospasm after prolonged verapamil infusion. There was no CT scanning evidence of new ischemic events in 9 of the 12 patients treated. At last clinical follow-up 6-12 months after discharge, 8 of 11 patients had a modified Rankin Scale score ≤2.
Prolonged intraarterial infusion of verapamil is a safe and effective treatment for medically refractory severe vasospasm and reduces the need for angioplasty in such cases.
血管痉挛是蛛网膜下腔出血（SAH）后发病率和死亡率的主要原因之一。尽管进行了最佳的药物治疗，许多患者仍遭受严重的中风。血管内治疗是治疗药物难治性血管痉挛的最后手段。作者介绍了一系列通过留置微导管进行持续动脉内维拉帕米输注治疗的患者。
在一年的时间里，作者确定了 12 例因颅内动脉瘤性 SAH 导致药物难治性血管痉挛的患者。回顾性收集数据，包括年龄、性别、Hunt 和 Hess 分级、Fisher 分级、动脉瘤位置、动脉瘤治疗、血管痉挛发作的天数、颅内压、平均动脉压、血管痉挛的动脉内治疗、维拉帕米输注的剂量和时间、CT 扫描上新出现的缺血区域、出院时和最后临床随访时的改良 Rankin 量表评分以及出院状态。
共进行了 27 次治疗。每支血管输注 25 至 360 毫克维拉帕米（每支血管平均剂量 164.6 毫克，每次治疗的总剂量范围为 70-720 毫克）。输注时间从 1 至 20.5 小时不等（平均 7.8 小时）。每个患者的治疗血管数量从 1 到 7 不等。每个患者的治疗次数从 1 到 4 次不等。没有与治疗相关的发病率或死亡。血压和颅内压变化是短暂的，且迅速可逆。在 36 个治疗血管中，32 例患者的延长维拉帕米输注完全有效，4 例患者部分有效。仅在 4 例血管对延长维拉帕米输注后仍存在难治性血管痉挛的情况下进行了血管成形术。在 12 例接受治疗的患者中，有 9 例 CT 扫描未见新的缺血事件证据。在出院后 6-12 个月的最后临床随访中，11 例患者中有 8 例改良 Rankin 量表评分≤2。
延长动脉内维拉帕米输注是治疗药物难治性严重血管痉挛的一种安全有效的方法，并可减少此类情况下血管成形术的需要。
