PT  - JOURNAL ARTICLE
AU  - Sequeiros, J.M.
AU  - Roa, J.A.
AU  - Sabotin, R.P.
AU  - Dandapat, S.
AU  - Ortega-Gutierrez, S.
AU  - Leira, E.C.
AU  - Derdeyn, C.P.
AU  - Bathla, G.
AU  - Hasan, D.M.
AU  - Samaniego, E.A.
TI  - Quantifying Intra-Arterial Verapamil Response as a Diagnostic Tool for Reversible Cerebral Vasoconstriction Syndrome
AID  - 10.3174/ajnr.A6772
DP  - 2020 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1869--1875
VI  - 41
IP  - 10
4099  - http://www.ajnr.org/content/41/10/1869.short
4100  - http://www.ajnr.org/content/41/10/1869.full
SO  - Am. J. Neuroradiol.2020 Oct 01; 41
AB  - BACKGROUND AND PURPOSE: There is mounting evidence supporting the benefit of intra-arterial administration of vasodilators in diagnosing reversible cerebral vasoconstriction syndrome. We prospectively quantified the degree of luminal diameter dilation after intra-arterial administration of verapamil and its accuracy in diagnosing reversible cerebral vasoconstriction syndrome.MATERIALS AND METHODS: Patients suspected of having intracranial arteriopathy on noninvasive imaging and referred for digital subtraction angiography were enrolled in a prospective registry. Intra-arterial verapamil was administered in vascular territories with segmental irregularities. The caliber difference (Caliberpost − Caliberpre) and the proportion of caliber change ([(Caliberpost − Caliberpre)/Caliberpre] × 100%) were used to determine the response to verapamil. The diagnosis of reversible cerebral vasoconstriction syndrome was made on the basis of clinical and imaging features at a follow-up appointment, independent of the reversibility of verapamil. Receiver operating characteristic curve analysis was performed to determine the best threshold.RESULTS: Twenty-six patients were included, and 9 (34.6%) were diagnosed with reversible cerebral vasoconstriction syndrome. A total of 213 vascular segments were assessed on diagnostic angiography. Every patient with a final diagnosis of reversible cerebral vasoconstriction syndrome responded to intra-arterial verapamil. The maximal proportion of change (P < .001), mean proportion of change (P = .002), maximal caliber difference (P = .004), and mean caliber difference (P = .001) were statistically different between patients with reversible cerebral vasoconstriction syndrome and other vasculopathies. A maximal proportion of change  ≥32% showed a sensitivity of 100% and a specificity of 88.2% to detect reversible cerebral vasoconstriction syndrome (area under the curve = 0.951). The Reversible Cerebral Vasoconstriction Syndrome-2 score of  ≥5 points achieved a lower area under the curve (0.908), with a sensitivity of 77.8% and a specificity of 94.1%.CONCLUSIONS: Objective measurement of the change in the arterial calibers after intra-arterial verapamil is accurate in distinguishing reversible cerebral vasoconstriction syndrome from other vasculopathies. A proportion of change  ≥32% has the best diagnostic performance.AUCarea under the curveCDcaliber differenceIAintra-arterialICADintracranial atherosclerotic diseaseDSAdigital subtraction angiographyPACNSprimary angiitis of the central nervous systemPCproportion of changeRCVSreversible cerebral vasoconstriction syndromeROCreceiver operating characteristicTCHthunderclap headache