Effect of Calcium Antagonist (Diltiazem) on Symptomatic Cerebral Vasospasm

Abstract

The mechanism of action of Ca2+ antagonist has been postulated to be a transmembrane calcium influx blockade. The effect of intra-arterial and intra-thecal administrations of diltiazem on experimental cerebral vasospasm has been previously reported by the authors. A pilot study, examining the clinical effect of diltiazem on symptomatic cerebral vasospasm, was done. This study included 105 patients with a ruptured supratentorial aneurysm, who were operated on at acute or chronic stage. They were classified preoperatively according to the Hunt and Hess neurological grading system; 18 in grade I, 30 in grade II, 37 in grade III, and 20 in grade IV. Patients in grade V were excluded from this study. After the aneurysm was clipped, 7.3 X10-6M diltiazem was applied topically to the exposed arterial segments. Subsequently, patients received a continuous intravenous diltiazem infusion (60 mg/24 hrs) for several days, followed as soon as possible by oral administration (90 mg/day). The duration of treatment by diltiazem was 2 weeks following the operation. Recently, an preoperative administration of diltiazem was carried out. One hundred and five cases (diltiazem group) were compared with a control group of 100 cases who were operated on before administration of diltiazem started. The appearance and severity of symp tomatic cerebral vasospasm was not affected by diltiazem, but the outcome of the grade II and III patients with or without vasospasm improved significantly at 3-month follow-up examination. Systemic hypotension was not induced by the routes or doses of administration of diltiazem. The preliminary results reported here indicate that diltiazem may prove to have an additional anti-ischemic effect. © 1986, The Japan Neurosurgical Society. All rights reserved.