RT Journal Article
SR Electronic
T1 Morphological changes of intracranial pressure quantifies vasodilatory effect of verapamil to treat cerebral vasospasm
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 802
OP 808
DO 10.1136/neurintsurg-2019-015499
VO 12
IS 8
A1 Xiuyun Liu
A1 Jeffrey R Vitt
A1 Steven W Hetts
A1 Koa Gudelunas
A1 Nhi Ho
A1 Nerissa Ko
A1 Xiao Hu
YR 2020
UL http://jnis.bmj.com/content/12/8/802.abstract
AB Introduction After aneurysmal subarachnoid hemorrhage (SAH), both proximal and distal cerebral vasospasm can contribute to the development of delayed cerebral ischemia. Intra-arterial (IA) vasodilators are a mainstay of treatment for distal arterial vasospasm, but no methods of assessing the efficacy of interventions in real time have been established.Objective To introduce a new method for continuous intraprocedural assessment of endovascular treatment for cerebral vasospasm.Methods The premise of our approach was that distal cerebral arterial changes induce a consistent pattern in the morphological changes of intracranial pressure (ICP) pulse. This premise was demonstrated using a published algorithm in previous papers. In this study, we applied the algorithm to calculate the likelihood of cerebral vasodilation (VDI) and cerebral vasoconstriction (VCI) from intraprocedural ICP signals that are synchronized with injection of the IA vasodilator, verapamil. Cerebral blood flow velocities (CBFVs) on bilateral cerebral arteries were studied before and after IA therapy.Results 192 recordings of patients with SAH were reviewed, and 27 recordings had high-quality ICP waveforms. The VCI was significantly lower after the first verapamil injection (0.47±0.017) than VCI at baseline (0.49±0.020, p<0.001). A larger dose of injected verapamil resulted in a larger and longer VDI increase. CBFV of the middle cerebral artery increases across the days before the injection of verapamil and decreases after IA therapy.Conclusion This study provides preliminary validation of an algorithm for continuous assessment of distal cerebral arterial changes in response to IA vasodilator infusion in patients with vasospasm and aneurysmal SAH.