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The impact of Verapamil for radial access in diagnostic cerebrovascular angiograms: A retrospective case-control

Dominic Romeo1, Mohamed M Salem1, Georgios S Sioutas1

  • 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|August 14, 2023
PubMed

Insights

Verapamil in neuroendovascular procedures did not significantly reduce vasospasm and was linked to hives. Prophylactic Verapamil may not be necessary for radial or ulnar artery catheterization.

Area of Science:

  • Neuroendovascular procedures
  • Vascular access
  • Pharmacology

Background:

  • Medication cocktails are used during radial artery (RA) or ulnar artery (UA) catheterization for neuroendovascular procedures to prevent vasospasm.
  • These cocktails often include Verapamil, a calcium channel blocker, despite a lack of established benefit.

Purpose of the Study:

  • To analyze the outcomes of patients who received Verapamil versus those who did not during wrist access for neuroendovascular procedures.
  • To determine if Verapamil reduces vasospasm or increases the incidence of side effects like skin rashes.

Main Methods:

  • A retrospective review of a prospective log of patients undergoing diagnostic cerebral angiograms via RA/UA access.
  • Patients were divided into Verapamil and non-Verapamil cohorts.
  • Primary outcomes assessed were forearm skin rashes (hives) and RA/UA spasms.

Main Results:

  • 221 patients underwent 241 procedures; 149 received Verapamil and 92 did not.
  • 2.7% of patients in the Verapamil group developed hives, compared to 0% in the non-Verapamil group.
  • One patient (1.1%) in the non-Verapamil group experienced vasospasm, while no vasospasm was reported in the Verapamil group.

Conclusions:

  • Verapamil administration during wrist access for diagnostic cerebral angiograms was associated with periprocedural hives.
  • Verapamil was not associated with a significant reduction in vasospasm compared to the non-Verapamil group.
  • Prophylactic Verapamil may not be necessary for these neuroendovascular procedures.

Keywords:
Hivesdiagnostic cerebral catheter angiogramradial “cocktail”transradial accessverapamil

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