Morphological Changes of ICP Quantifies Vasodilatory Effect of Verapamil to Treat Cerebral Vasospasm

What is it about?

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, however there are no well-established methods to assess the efficacy of interventions in real-time. This study validates an algorithm for continuous assessment of distal cerebral arterial changes in response to IA vasodilator infusion in patients with vasospasm and aneurysmal SAH, which has the potential for clinical use in the future.

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Photo by Robina Weermeijer on Unsplash

Photo by Robina Weermeijer on Unsplash

Why is it important?

The premise of our approach is 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. We applied the algorithm to calculate the likelihood of cerebral vasodilation (VDI) and cerebral vasoconstriction (VCI) from intra-procedural ICP signals that are synchronized with injection of IA vasodilator verapamil. The result showed that the VCI was significantly lower after the first verapamil injection than VCI at baseline. Larger dosage of verapamil injection results in larger and longer VDI increase.

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