Affiliations: Department of Neurological Surgery, University of
Florida, Gainesville, FL, USA | Department of Neurological Surgery, Vanderbilt
University Medical Center, Nashville, TN, USA | Department of Radiology, University of Florida,
Gainesville, FL, USA
Note: [] Correspondence: Robert A. Mericle, M.D., Department of
Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical
Center North, Nashville, TN 37232-2380, USA. Tel.: +1 615 322 6638; Fax: +1 615
343 8104; E-mail: Robert.Mericle@vanderbilt.edu
Abstract: No proven medical therapy exists for the treatment of moyamoya
disease. Case reports have suggested that calcium channel blockers may be
beneficial, potentially improving cerebral blood flow through a vasodilatory
effect. The first objective of this pilot study was to prospectively evaluate
whether intraarterial nitroglycerin, a potent vasodilator, could improve
angiographic cerebral circulation in moyamoya patients. The second objective
was to monitor the safety profile of transdermal nitroglycerin in our cohort of
patients. Intraarterial nitroglycerin was infused in five patients with
moyamoya disease at escalating doses. Angiography was performed before and
after the nitroglycerin infusion. Pre- and post-infusion angiograms were
compared for angiographic improvement. The contralateral side was used as an
internal control in patients with unilateral moyamoya disease. The patients
were then placed on a transdermal nitroglycerin patch and followed with serial
neurological exams, blood pressure measurements, and either follow-up
angiography or single photon emission computed tomography scans. All five
patients had evidence of angiographic improvement after nitroglycerin infusion
in the affected arteries, but no change was identified in the control arteries
of patients with unilateral disease. No patient had adverse effects from either
intraarterial or transdermal nitroglycerin. This small pilot study demonstrates
angiographic improvement after intraarterial nitroglycerin in affected moyamoya
arteries, but not in control arteries in the same patients, if present. There
were no complications associated with transdermal nitroglycerin in these
patients.
