Introduction/Purpose Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by multifocal arterial narrowing of cerebral vessels. Numerous studies have demonstrated improvement in cerebral vessel caliber following administration of intra‐arterial verapamil (IAV), though these studies have traditionally used subjective methods for determining improvements in vessel caliber. Additionally, the link between location and severity of vasoconstriction and functional outcome or hemorrhagic complications is also not clear. In this study we devised a method for objective quantification of vessel caliber improvement following IAV and recorded these changes across different vascular territories. We hypothesize that the magnitude of vessel caliber change following IAV is a surrogate for severity of vasoconstriction and has an association with functional outcomes. Materials/Methods Patients diagnosed with RCVS between 2019 to 2025 at the University of Iowa were included in the study. Picture archiving and communication software was used to measure the proximal and distal caliber of the most stenotic portion of each affected cerebral artery before and after IAV administration. Patient functional outcomes were determined using the modified Rankin scale (mRS), with functional independence defined as mRS < 2 at 90 days. Hemorrhagic complications on admission including intraparenchymal hemorrhage (IPH), cortical subarachnoid hemorrhage (cSAH), and subdural hematoma (SDH) were tracked. Data were analyzed using univariate and multivariate logistic regression to assess the relationship between clinical features (thunderclap headache, systolic blood pressure) and hemorrhagic complications, functional independence, and percent change in area of cerebral vessels following IAV. Results Imaging data from thirty‐two patients with RCVS were analyzed. Greater arterial caliber improvement following IAV in distal vascular territories correlated with cSAH on admission (aOR: 1.07, 95% CI: 1.01 ‐ 1.12, P < 0.01), particularly in distal anterior cerebral artery segments (aOR: 1.10, 95% CI: 1.01 ‐ 1.22, P < 0.001). Furthermore, a greater degree of arterial caliber improvement after IAV in distal segments was also associated with decreased odds of functional independence (aOR: 0.95, 95% CI: 0.93 ‐ 0.98, P = 0.02). From a clinical standpoint, greater systolic blood pressure on admission was also associated with decreased odds of functional independence (aOR: 0.96, 95% CI: 0.92 ‐ 0.99, P = 0.03; see Figure 1). Conclusion In this study involving patients with RCVS, a larger change in distal cerebral vessel area following IAV administration was associated both with cSAH on admission as well as poor functional outcomes. image
Jaramillo et al. (Sat,) studied this question.