Increase in diameters of vasospastic intracranial arteries by intraarterial papaverine administration

Abstract

In all treatment groups an increase was found in the average arterial diameters ranging from 2.8 to 73.9%, with a mean increase of 26.5%. Increases in diameter were observed in proximal, intermediate, and distal arteries. The timing of treatments ranged from Day 3 to Day 19 post-SAH, and there was no relationship between timing and arterial responsiveness (r = -0.06). There was a moderately good correlation between the degree of vasospasm in an artery and its responsiveness to papaverine (r = -0.54, -0.66, and -0.66, for proximal, intermediate, and distal arteries, respectively). The effect of papaverine did not persist until the following day in patients in whom repeated angiography was performed.

Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage–induced cerebral vasospasm

“…Vasospasm is subjectively graded as mild, moderate, or severe. 17 After vasospasm is angiographically diagnosed, a choice is made between medical and endovascular treatment. This decision is reached through discussion among the attending interventional neuroradiologist, neurosurgeon, and neurointensivist.…”

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

“…Vessels with more vasospasm and narrower lumens have been shown to respond to papaverine treatment with greater increases in vessel diameter. 37 The degree of arterial responsiveness, however, was independent of the post-SAH day of treatment.…”

“…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%.…”

“…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.…”

Treatment Options for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

“…However, repeated injections have been associated with worse clinical outcomes in several case series [74][75][76]. Advancements in microcatheter technology have made the super selective catheterization of third and fourth order cerebral vessels possible, allowing for slow infusion of vasodilators, perhaps reducing side effects [70,71,77,78]. Case series report the use of other IA vasodilators, including verapamil, nicardipine, nimodipine, and milrinone [35,[79][80][81][82][83].…”