Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm

Liu, James K.; Tenner, Michael; Gottfried, Oren N.; Stevens, Edwin A.; Rosenow, Joshua M.; Madan, Neel; MacDonald, Joel D.; Kestle, John R. W.; Couldwell, William T.

doi:10.3171/jns.2004.100.3.0414

Cited by 60 publications

(32 citation statements)

References 34 publications

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“…8,10,12,14,17,26,27,34,35,42,45,46,49,58 Liu, et al, 34 reported clinical improvement in 12 (71%) of 17 patients; eight patients had improvement of depressed level of consciousness, one had reversal of upper-extremity weakness, and three had improvement of vasospasm-induced aphasia. In a review of the literature by Hoh and Ogilvy, 23 clinical improvement after papaverine infusion was demonstrated in 148 (43%) of 346 patients.…”

Section: Clinical Effects and Outcomesmentioning

confidence: 99%

“…ter; 8,37 to improve CBF by dilating the proximal, intermediate, and distal cerebral arteries; 8 to improve mean cerebral circulation time; 34,36 and to improve cerebral oxygenation.…”

Section: Clinical Effects and Outcomesmentioning

confidence: 99%

“…46 Although many anecdotal and retrospective reports in the literature have documented improved neurological outcomes after intraarterial papaverine, findings in studies of its clinical efficacy remain inconclusive and its precise role in treating vasospasm has yet to be determined in controlled prospective randomized trials. 45 Intraarterial papaverine has been noted to be effective in increasing angiographically demonstrated vessel diame-C. M. Sayama, J. K. Liu, and W. T. Couldwell ter; 8,37 to improve CBF by dilating the proximal, intermediate, and distal cerebral arteries; 8 to improve mean cerebral circulation time; 34,36 and to improve cerebral oxygenation. 14 In a study by Oskouian, et al, 42 intraarterial papaverine infusions increased vessel diameter in 20 patients by an average of 30.1%.…”

Section: Clinical Effects and Outcomesmentioning

confidence: 99%

“…33 Milburn, et al, 36 showed a decrease in cerebral circulation time after intraarterial papaverine infusions in 58 of 59 carotid territories in 27 patients. Liu, et al, 34 demonstrated that patients with clinical vasospasm exhibited a prolonged cerebral circulation time compared with a control group of patients without vasospasm. They also showed that intraarterial papaverine treatments decreased the mean cerebral circulation time from 6.54 to 4.19 seconds (p Ͻ 0.001, 36% decrease).…”

Section: Clinical Effects and Outcomesmentioning

confidence: 99%

“…2), and it may be administered alone or in combination with transluminal balloon angioplasty. 8,26,27,33,34,42 Because papaverine is a potent vasodilator of the proximal, intermediate, and distal cerebral arteries, its use may be advantageous in treating diffuse nonfocal vasospasm and distal vasospastic vessels that are inaccessible by balloon angioplasty techniques. Papaverine may also be administered as an adjunct to dilate vessels and facilitate placement of the balloon catheter for angioplasty.…”

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confidence: 99%

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Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage

Sayama¹,

Liu²,

Couldwell³

2006

FOC

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✓Cerebral vasospasm remains a major source of morbidity and death in patients with aneurysmal subarachnoid hemorrhage (SAH). When vasospasm becomes refractory to maximal medical management consisting of induced hypertension and hypervolemia and administration of calcium channel antagonists, endovascular therapies should be considered. The primary goal of endovascular treatment is to increase cerebral blood flow to prevent cerebral infarction. Two of the more frequently studied endovascular treatments are transluminal balloon angioplasty and intraarterial papaverine infusion. These two have been used either alone or in combination for the treatment of vasospasm. Other pharmacological vasodilating agents currently being investigated are intraarterial nimodipine, nicardipine, verapamil, and milrinone. Newer intraarterial agents, such as fasudil and colforsin daropate, have also been investigated. In this article the authors review the current options in terms of endovascular therapies for treatment of cerebral vasospasm. The mechanism of action, technique of administration, clinical effect and outcomes, and complications of each modality are discussed.

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Section: Clinical Effects and Outcomesmentioning

confidence: 99%

“…ter; 8,37 to improve CBF by dilating the proximal, intermediate, and distal cerebral arteries; 8 to improve mean cerebral circulation time; 34,36 and to improve cerebral oxygenation.…”

Section: Clinical Effects and Outcomesmentioning

confidence: 99%