Duration of Vasodilatory Action After Intra-arterial Infusions of Calcium Channel Blockers in Animal Model of Cerebral V
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ORIGINAL WORK
Duration of Vasodilatory Action After Intra‑arterial Infusions of Calcium Channel Blockers in Animal Model of Cerebral Vasospasm Jeongwook Lim1, Young Dae Cho2*, Hyon‑Jo Kwon1, Soo Hyoung Byoun1, Hyeon‑Song Koh1, Bumsoo Park1 and Seung‑Won Choi1 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: In medically refractory vasospasm, invasive intervention may be required. A commonly used approach is intra-arterial (IA) drug infusion. Although calcium channel blockers (CCBs) have been widely applied in this set‑ ting, studies comparing their efficacies and durations of action have been few. This study was performed to compare attributes of three CCBs (nicardipine, nimodipine, and verapamil), focusing on duration of the vasodilatory action based on angiography. Methods: Vasospasm was produced in New Zealand white rabbits (N = 22) through experimentally induced suba‑ rachnoid hemorrhage and confirmed in each via conventional angiography, grouping them by IA-infused drug. After chemoangioplasty, angiography was performed hourly for 5 h to compare dilated and vasospastic arterial diameters. Drug efficacy, duration of action, and changes in mean arterial pressure (relative to baseline) were analyzed by group. Results: Effective vasodilation was evident in all three groups immediately after IA drug infusion. The vasodilative effects of nimodipine and nicardipine peaked at 1 h and were sustained at 2 h, returning to initial vasospastic states at 3 h. In verapamil recipients, effects were more transient by comparison, entirely dissipating at 1 h. Only the nicardi‑ pine group showed a significant 3-h period of lowered blood pressure. Conclusions: Although nimodipine and nicardipine proved longer acting than verapamil in terms of vasodilation, their effects were not sustained beyond 2 h after IA infusion. Further study is required to confirm the vasodilatory duration of IA CCB based on perfusion status, and an effort should be made to find new alternative to extend the duration. Keywords: Subarachnoid hemorrhage, Vasospasm, Chemoangioplasty, Intra-arterial infusion, Calcium channel blocker Introduction Vasospasm after rupture of cerebral aneurysms is the primary cause of heightened patient morbidity and mortality and is a relatively common complication of *Correspondence: [email protected] 2 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak‑ro, Jongno‑gu, Seoul 03080, Korea Full list of author information is available at the end of the article
subarachnoid hemorrhage (SAH) seen by angiogram in two-thirds of patients with rupture and one-third of those with clinical symptoms [1, 2]. Despite rapid advancements made in surgical and endovascular treatments of cerebral aneurysms, mortality/morbidity due to vasospasm has remained unchanged. The etiology of vasospasm is thus poorly understood, leaving a void in definitive treatments for severely symptomatic patients who are then
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