Repeat intra-arterial papaverine for recurrent cerebral vasospasm after subarachnoid haemorrhage

• Published in: Neuroradiology Vol. 39; no. 10; pp. 751 - 759
• Main Authors: NUMAGUCHI, Y, ZOARSKI, G. H, CLOUSTON, J. E, ZAGARDO, M. T, SIMARD, J. M, ALDRICH, E. F, SLOAN, M. A, MAURER, P. K, OKAWARA, S. H
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.10.1997
• Subjects: Adult; Aged; Biological and medical sciences; Cardiovascular system; Cerebral Angiography - drug effects; Female; Humans; Injections, Intra-Arterial; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - drug therapy; Medical sciences; Middle Aged; Papaverine - administration & dosage; Pharmacology. Drug treatments; Recurrence; Retreatment; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Treatment Outcome; Vasodilator Agents - administration & dosage; Vasodilator agents. Cerebral vasodilators; Human; Nervous system diseases; Prevalence; Vasodilator agent; Radiodiagnosis; Angiography; Cardiovascular disease; Recurrent; Cerebral artery; Epidemiology; Hemorrhage; Cerebral disorder; Vascular disease; Multiple dose; Chemotherapy; Treatment; Antispasmodic agent; Central nervous system disease; Subarachnoid; Vasospasm; Intraarterial administration; Papaverine; Cerebrovascular disease
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s002340050501

We assessed the prevalence of recurrent vasospasm following failure of intra-arterial papaverine and the efficacy of repeat intra-arterial infusions of papaverine for control of recurrent vasospasm. Of 24 patients treated with intra-arterial papaverine for vasospasm following aneurysm surgery, 12 did not improve clinically after the initial treatment; 9 received second or third infusions on consecutive days; 6 received only a second infusion; and 3 received a third. Superselective infusion into the intracranial arteries was performed in all nine cases. Despite angiographic improvement after the initial or second infusions, all nine patients showed varying degrees of recurrent vasospasm at the time of the second or third treatment. Within 24 h of a second infusion, three of the six patients had significant clinical improvement, and one of these showed marked improvement soon after a third infusion. Our preliminary results suggest that repeat papaverine infusion may be a way of controlling recurrent or recalcitrant vasospasm.