The Effect of Intra-Arterial Papaverine Injection in Cerebral Vasospasm

Park, Sang June; Choi, Chang Hwa

Abstract

Cerebral vasospasm continues to be the leading cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. In this study, 10 patients who showed clinical and angiographic vasospasm treated with internal carotid papaverine infusion(total dose: 180-300 mg/one hour). Two patients had marked angiographic reversal of the arterial narrowing following papaverine infusion and dramatic reversal of profound neurologic deficits. The final outcome of these patients was good recovery. Four patients showed decreased circulation time on angiography and three of these patients improved clinical status, but deteriorated conscious level 3-4 days after papaverine infusion. One of these patient, vasospasm was observed on repeated angiography, but no more papaverine was infused and finally showed severe disability. The second patient developed cardiac arrest during re-papaverine infusion, so cessation of the intra-arterial infusion and CPCR was done, but she died. The third patient did not perform angiography and final outcome was moderate disability. The remained 4 patients showed nonspecific change in angiography after papaverine infusion and all of these patients died. Arterial narrowing in middle cerebral artery distribution appeared to be more responsive to papaverine infusion than the spasm in the anterior cerebral arteries. The over all results of intra-arterial papaverine infusion was at least partially effective, but not satisfactory to relieve clinical and angiographic vasospam. The further more exact infusion method should be clarified to improve vasospasm through papaverine injection.