Iatrogenic arterial spasm relieved by intraarterial mannitol infusion

Abstract

Catheter placement for blood brain-barrier disruption and enhanced chemotherapy delivery can sometimes trigger arterial spasm of moderate-to-severe degree. A slow infusion of a small quantity of intraarterially administered mannitol (10 mL of 25% mannitol) was evaluated as a means to obtain a rapid resolution of catheter placement-induced spasm. We prospectively report 12 consecutive cases of blood brain-barrier disruption among patients who developed catheter placement-induced spasm that was treated by this means without side effects, resulting in rapid resolution of spasm.

fig 1.

Spasm was typically identified when testing to confirm catheter position. A, Arterial spasm in the right internal carotid artery identified at the time of catheter placement before mannitol infusion in patient 11. Open arrow depicts the tip of the catheter in the right internal carotid artery, with 80% concentric spasm extending up for 1.5 cm (arrowhead) after infusion of a nonionic iodinated contrast agent. B, Complete resolution of spasm (arrowhead) after slow intraarterial infusion of 10 mL of mannitol in the right internal carotid artery.