Intra-arterial administration of verapamil for prevention and treatment of cerebral angiospasm after SAH due to cerebral aneurysm rupture

Mikeladze K.G.; Okishev D.N.; Belousova O.B.; Konovalov An.N.; Pilipenko Iu.V.; Kheireddin A.S.; Ageev I.S.; Shekhtman O.D.; Kurdyumova N.V.; Tabasaranskiĭ T.F.; Okisheva E.A.; Éliava Sh.Sh.; Yakovlev S.B.

doi:https://doi.org/10.17116/neiro201882423

Mikeladze K.G.

Burdenko’ National medical research center of neurosurgery, Moscow, Russia

Okishev D.N.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Belousova O.B.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

ORCID: 0000-0003-4908-8923

Konovalov An.N.

Burdenko Neurosurgical Institute, Moscow, Russia

Pilipenko Iu.V.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kheireddin A.S.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

ORCID: 0000-0002-6395-2055

Ageev I.S.

Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

Shekhtman O.D.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kurdyumova N.V.

Federal State Autonomous Institution «N.N. Burdenko National Medical Research Center for Neurosurgery» of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047, Moscow, 4-th Tverskaya-Yamskaya str.,16, Russia

Tabasaranskiĭ T.F.

FGBU "NII neĭrokhirurgii im. N.N. Burdenko" RAMN, Moskva

Okisheva E.A.

GBOU VPO Pervyĭ MGMU im. I.M. Sechenova Minzdrava Rossii

Éliava Sh.Sh.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Yakovlev S.B.

Burdenko’ National medical research center of neurosurgery, Moscow, Russia

ORCID: 0000-0002-0798-2604

Intra-arterial administration of verapamil for prevention and treatment of cerebral angiospasm after SAH due to cerebral aneurysm rupture

Authors:

Mikeladze K.G., Okishev D.N., Belousova O.B., Konovalov An.N., Pilipenko Iu.V., Kheireddin A.S., Ageev I.S., Shekhtman O.D., Kurdyumova N.V., Tabasaranskiĭ T.F., Okisheva E.A., Éliava Sh.Sh., Yakovlev S.B.

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Journal: Burdenko's Journal of Neurosurgery. 2018;82(4): 23‑31

DOI: 10.17116/neiro201882423

Read: 3973 times

To cite this article:

Mikeladze KG, Okishev DN, Belousova OB, et al. Intra-arterial administration of verapamil for prevention and treatment of cerebral angiospasm after SAH due to cerebral aneurysm rupture. Burdenko's Journal of Neurosurgery. 2018;82(4):23‑31. (In Russ., In Engl.)
https://doi.org/10.17116/neiro201882423

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

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Abstract:

Aim — the study purpose was to analyze the efficacy of intra-arterial administration of verapamil (IAV) in the treatment of angiospasm in SAH patients and to determine optimal parameters of the procedure. A number of studies demonstrated the efficacy of intra-arterial administration of vasodilators, in particular verapamil, in the treatment of angiospasm after aneurysmal SAH, which served the basis for inclusion of this method in the recommended protocol for treatment of SAH patients [1―7]. Material and methods. We analyzed the efficacy of IAV in 35 patients in the acute period of SAH, with 77.2% of the patients having a Hunt-Hess score of III―V. The inclusion criteria were as follows: IAV within two weeks after SAH; excluded aneurysm; verapamil dose per administration of at least 15 mg; follow-up for at least three months. Efficacy endpoints were as follows: changes in spasm according to angiography and transcranial dopplerography (TCDG); development of ischemic lesions; clinical outcome according to the modified Rankin scale. Results. A total of 76 IAV procedures were performed. The verapamil dose per procedure was 36.7±9.7 mg, on average; the number of procedures varied from 1 to 5. One arterial territory was treated in 12 cases, two arterial territories were treated in 48 cases, and three arterial territories were treated in 15 cases. Typical adverse reactions included decreased blood pressure, a reduced heart rate, and elevated ICP. In all cases, TCDG revealed signs of reduced angiospasm ― a 20―40% decrease in the LBFV in the M1 MCA. Four (11.4%) patients died; of these, only one died due to angiospasm progression. On examination at 3 months or more after discharge, favorable outcomes were observed in 74.3% of cases. Conclusion. IAV is associated with a low risk of significant complications. IAV should be performed under control of systemic hemodynamics and ICP. The indications for IAV include signs of moderate worsening or severe angiospasm according to TCDG and/or angiography. The IAV procedure may be performed every day. Further clarification of the IAV procedure and evaluation of clinical outcomes under prospective study conditions are required.

Keywords:

SAH

angiospasm treatment

intra-arterial administration of verapamil

Authors:

Mikeladze K.G.

Burdenko’ National medical research center of neurosurgery, Moscow, Russia

Okishev D.N.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Belousova O.B.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

ORCID: 0000-0003-4908-8923

Konovalov An.N.

Burdenko Neurosurgical Institute, Moscow, Russia

Pilipenko Iu.V.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kheireddin A.S.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

ORCID: 0000-0002-6395-2055

Ageev I.S.

Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

Shekhtman O.D.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kurdyumova N.V.

Tabasaranskiĭ T.F.

FGBU "NII neĭrokhirurgii im. N.N. Burdenko" RAMN, Moskva

Okisheva E.A.

GBOU VPO Pervyĭ MGMU im. I.M. Sechenova Minzdrava Rossii

Éliava Sh.Sh.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Yakovlev S.B.

Burdenko’ National medical research center of neurosurgery, Moscow, Russia

ORCID: 0000-0002-0798-2604

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