Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is a neurologic disorder where persistent untreated cerebral vasoconstriction can lead to permanent neurologic disability and even death. There is currently no standard treatment algorithm. Patients are typically treated with oral calcium channel blockers. Reports of endovascular treatment of RCVS is sparse. We report the largest published case series to date of intra-arterial verapamil infusion for the treatment of RCVS.

Methods: A retrospective review of was performed based on records from the neuro-endovascular database of patients who were treated at a single institution for RCVS from 2011 to 2016.

Results: A total of six patients were treated with intra-arterial verapamil, all with immediate radiographic improvement and improved neurologic outcomes post procedurally and upon discharge. Patients also received oral nimodipine, verapamil, or amlodipine. The average length of hospitalization was 9 days. One patient required a second intra-arterial infusion of verapamil for persistent neurologic deficits. One patient had a femoral artery pseudoaneurysm treated successfully with thrombin injection. There were no other procedural complications. Average NIH stroke score (NIHSS) on admission was 4.33 (0 to 16) and upon discharge was 0.5 (0 to 2). NIHSS were improved on average by 3.66 (Range of 0 to 16) when compared to admission versus discharge NIHSS.

Conclusions: Neuroangiography is not only an important diagnostic tool, but an important therapeutic option for the treatment of RCVS. Intra-arterial infusion of verapamil in addition to oral calcium channel blockers can provide rapid and sustained improvement in symptoms of RCVS and has a low complication profile.

Patient Care: The goal of this research is to increase the visibility of endovascular procedures in the treatment of RCVS and other possible vascular diseases that may respond to local vasodilator therapy.

Learning Objectives: By the conclusion of this session, participants should be able to describe the benefits of endovascular treatment for reversible cerebral vasoconstriction syndrome.

References: Kass-Hout T, Kass-Hout O, Sun CH, Kass-Hout T, Ramakrishnan 1. P, Nahab F, Nogueira R, Gupta R. A novel approach to diagnose reversible cerebral vasoconstriction syndrome: a case series. J Stroke Cerebrovasc Dis. 2015 Jan;24(1):e31-7. French KF, Hoesch RE, Allred J, Wilder M, Smith AG, Digre KB, La Barge DV 3rd. Repetitive use of intra-arterial verapamil in the treatment of reversible cerebral vasoconstriction syndrome. J Clin Neurosci. 2012 Jan;19(1):174-6 Farid H, Tatum JK, Wong C, Halbach VV, Hetts SW. Reversible cerebral vasoconstriction syndrome: treatment with combined intra-arterial verapamil infusion and intracranial angioplasty. AJNR Am J Neuroradiol. 2011 ;32(10):E184-7.