Introduction: Excessive consumption of legal, over-the-counter stimulants is associated with coronary vasospasm, thrombotic complications, and sudden cardiac death; however, their untoward effects on cerebrovascular physiology are not yet described in the neuro-interventional literature. Patients are increasingly exposed to high levels of these vasoactive substances in the form of caffeinated energy drinks and specialty coffees.
Methods: We report a case of aneurysmal subarachnoid hemorrhage (SAH) and severe, catheter-induced vasospasm during attempted endovascular repair of a ruptured anterior communicating artery (AComA) aneurysm in the setting of excessive energy drink consumption. We review the literature and alert clinicians to this potentially serious complication.
Results: A 44yF presented as a HH2, F3 SAH secondary to a ruptured, wide-necked, 5-mm AComA aneurysm. She had habitual, excessive energy drink consumption including 5 oversized-cans of a commercial energy drink consumed that day. Prior to bringing a 6F Cook Shuttle into the distal R CCA, the patient was fully heparinized (ACT > 250). During attempted balloon-assisted coiling, she developed severe, flow-limiting, catheter-induced, precavernous-ICA vasospasm with subsequent thromboembolism into the right MCA. This was managed with withdrawal of the offending catheters, oro-gastric ASA, intra-arterial ReoPro (5-mg), and mechanical thrombectomy. Although she suffered a sizeable right MCA stroke, her aneurysm was successfully treated the following day after intra-arterial injection of verapamil through the guide catheter with notably less catheter-induced spasm.
Conclusions: Energy drink beverages are an increasingly popular form of caffeine consumption (80-160mg caffeine/drink) and also contain other vasoactive substances. These beverages are associated with endothelial dysfunction, vasoconstriction, thrombosis, and platelet aggregation. It is plausible that excessive energy drink consumption played a role in the unusual occurrence of such severe, catheter-induced vasospasm and clot formation. We recommend that clinicians routinely query their patients about excessive energy drink consumption.
Patient Care: Increased recognition of the potentially harmful effects of caffeine overindulgence in neurovascular patients may help to mitigate poor outcomes in clinical practice, it may be prudent to have individuals stop using such substances several days prior to elective neuro-interventional procedures.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) approximate the dose of caffeine in common drinks; 2) list the effects of caffeine on platelet aggregation and endothelial function; 3) describe the potential dangers of caffeine overindulgence on cardiac and cerebrovascular disease / treatment; 4) recognize potential precautionary measures for elective cases
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