INTRAARTERIAL PAPAVERINE INFUSION FOR CEREBRAL VASOSPASM AFTER SUBARACHNOID HEMORRHAGE

PURPOSE: To evaluate the techniques and efficacy of intracranial intra arterial papaverine infusion for symptomatic vasospasm after subarachn oid hemorrhage caused by aneurysm rupture. METHODS: Papaverine was inf used on 19 occasions in 14 patients, 6 hours to 2 days after spasm bec ame apparent clinically. Sixty vascular territories were treated. Infu sion was made into the supraclinoid internal carotid artery 20 times, cavernous internal carotid artery once, selective A1 anterior cerebral artery 8 times, M1 middle cerebral artery 7 times, and basilar artery 3 times. Papaverine doses ranged from 150 to 600 mg and exceeded 400 mg on 8 occasions. RESULTS: Angiographic improvement occurred in 18 (9 5%) of the 19 treatment sessions: results were excellent in 3 sessions , moderate in 8, and mild in 7. The best angiographic results often we re obtained with superselective infusion, although angiographic result s did not always correlate with clinical response. Seven (50%) of the 14 treated patients showed dramatic acute clinical improvement within 24 hours of papaverine therapy, and there was no clinical evidence of recurrent vasospasm in these patients. Recurrence of angiographic vaso constriction was demonstrated in three patients; one showed marked cli nical improvement after a second treatment. There were no episodes of systemic hypotension in any of the cases. Monocular blindness develope d in one patient because of papaverine infusion near the ophthalmic ar tery. CONCLUSIONS: Papaverine was effective in dilating narrowed arter ies in most patients with symptomatic vasospasm caused by subarachnoid hemorrhage. This series showed encouraging clinical results with no r ecurrence of neurologic deterioration in those patients who responded well to papaverine. Superselective infusion appears to be indicated in some cases for adequate papaverine delivery.