Background Cerebral vasospasm (CVS) is a major cause of morbidity and mortality after aneurysmal subarachanoid hemorrhage (aSAH). During medically refractory symptomatic CVS targeted intra-arterial (IA) vasodilators, such as verapamil, are routinely used. Despite evidence of radiographic improvement of vessel caliber, there is limited evidence of clinically substantial and persistent improved perfusion subsequent to IA verapamil.

Objective To evaluate effect of IA verapamil on down-stream brain tissue oxygen tension (PbTO2) in patients with angiographic vasospasm.

Methods All patients with poor grade aSAH who had a PbTO2 monitor and underwent digital subtraction angiography (DSA) for the evaluation of and treatment of CVS with IA-verapamil between 2013 and 2015 at UCLA. All patients that were found to have any extent of angiographic vasospasm were treated with IA verapamil to the corresponding internal carotid artery (ICA) or vertebral artery (VA). PbTO2 over the 24 hour epochs before and after each angiogram in the group with angiographic vasospasm was compared to group without vasospasm using a Student T-test.

Results We identified seven patients with aSAH who had PbTO2 monitoring during intervals before and after DSA for the evaluation and treatment of CVS. We found six distinct epochs with and six additional epochs without angiographic vasospasm. The average PbTO2 during a 24 hour epoch prior to DSA with spasm was significantly lower than the ones prior to DSA without vasospasm (18.4 vs 25.4, p=0.04). The average PbtO2 during a 24 hour epoch after DSA with evidence of angiographic vasospasm and treatment with IA verapamil normalized to the distribution of 24 epochs after DSA with no spasm who did not receive any treatment (23.2 vs 24.6, p=0.66).

Conclusion Intra-arterial verapamil could be used in normalizing pathologically low brain tissue oxygen tension in the setting of angiographic vasospasm. Further research is needed to understand appropriate dosing of IA verapamil by vasospasm severity.

Disclosures K. Khatibi: None. V. Szeder: None. M. Buitrago Blanco: None. S. Tateshima: None. R. Jahan: None. G. Duckwiler: None. P. Vespa: None.