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Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome
J M Sequeiros1, J A Roa1,2, R P Sabotin1
1From the Department of Neurology (J.M.S., J.A.R., R.P.S., S.D., S.O.-G., E.C.L., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa.
AJNR. American Journal of Neuroradiology
|September 18, 2020
Summary
Intra-arterial verapamil effectively diagnoses reversible cerebral vasoconstriction syndrome (RCVS). A 32% caliber change accurately identifies RCVS, distinguishing it from other vasculopathies.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) diagnosis benefits from intra-arterial vasodilator administration.
- Intra-arterial verapamil's role in diagnosing RCVS requires prospective quantification.
Purpose of the Study:
- To prospectively assess the diagnostic accuracy of intra-arterial verapamil in identifying reversible cerebral vasoconstriction syndrome.
- To quantify luminal diameter changes following verapamil administration for RCVS diagnosis.
Main Methods:
- Prospective registry of patients with suspected intracranial arteriopathy undergoing digital subtraction angiography.
- Intra-arterial verapamil administration in affected vascular territories; measurement of caliber changes.
- Diagnosis of RCVS based on clinical and imaging features, independent of verapamil response; ROC curve analysis.
Main Results:
- Nine of 26 patients (34.6%) were diagnosed with RCVS; all responded to intra-arterial verapamil.
- Statistically significant differences in caliber change between RCVS and other vasculopathies (P < .001).
- A maximal proportion of change ≥32% demonstrated 100% sensitivity and 88.2% specificity for RCVS (AUC=0.951).
Conclusions:
- Objective measurement of arterial caliber change post-verapamil accurately distinguishes RCVS from other vasculopathies.
- A proportion of change ≥32% offers optimal diagnostic performance for RCVS detection.
