Efficacy of controlled-release papaverine pellets in preventing symptomatic cerebral vasospasm

Abstract

Local application of controlled- or sustained-release papaverine can be safely used in preventing vasospasm.

Critical Care Guidelines on the Endovascular Management of Cerebral Vasospasm

“…Two-thirds of their patients showed marked angiographic improvement following treatment and 4 in 12 patients showed clinical improvement (33.3%). Multiple case series have reported successful treatment of cerebral vasospasm using intra-arterial papaverine, with good angiographic and clinical results [11][12][13][14][15][16][17][18][19][20][21][22] (See Table 1). Two studies, however, did not find clinical benefit [23,24], and one study reported neurological decline with possible neurotoxicity with intraarterial injection of papaverine [25].…”

“…Among selected articles, 3 addressed endovascular treatment timing [7][8][9], 12 papaverine [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], 4 verapamil [26][27][28][29], 3 nicardipine [30][31][32], and 27 balloon angioplasty [7][8][9][10]. The quality of evidence was low or very low for intraarterial treatments and moderate for balloon angioplasty.…”

The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal ubarachnoid Hemorrhage

“…In the late 1980s, endovascular angioplasty and injection of intra-arterial chemical vasodilators such as papaverine enabled to improve their overall outcome 2,[6][7][8][9]26,32,33) . However, because these medications and endovascular intervention are unable to eliminate the blood clots, cerebral vasospasm still contributes to poor outcome in approximately 10 to 40% of patients with dense SAH.…”

Advances in vasospasm treatment and prevention

“…Dalbasti et al, in an effort to overcome the temporary effects of papaverine, experimented with an implantable controlled-release papaverine pellet. Based on the results of their prospective study, which indicate a statistically significant difference in patient outcomes between the control and treatment groups (both average GOS scores and incidence of vasospasm), the authors concluded that when placed on arteries during vascular surgery, pellets releasing papaverine for 2 weeks could prevent the development of vasospasm with no noticeable complications [47].…”