Transluminal angioplasty and intra-arterial papaverine for the treatment of cerebral vasospasm after ruptured arteriovenous malformations

BACKGROUND This is the first report on the use of intra-arterial papaverine and percutaneous transluminal angioplasty in two patients with severe, sym ptomatic cerebral vasospasm who suffered ruptured arteriovenous malformatio ns (AVMs). CASE DESCRIPTIONS The source of hemorrhage was a venous aneurysm in the fir st case and a pedicular aneurysm of the distal posterior inferior cerebella r artery in the second case. In both cases, the AVMs were located in the su perior vermis and there was minimal subarachnoid hemorrhage. The first pati ent underwent removal of the AVM before the period of cerebral vasospasm an d the second patient underwent removal of the AVM after the cerebral vasosp asm had resolved. The outcome was excellent in the first patient and poor i n the second patient. CONCLUSION Arteriovenous malformation with ruptured aneurysms may be at hig h risk for cerebral vasospasm even when there is minimal subarachnoid hemor rhage. We recommend early treatment of AVMs with ruptured pedicular, intran idal, or venous aneurysms to avoid rebleeding and to allow for aggressive t reatment of cerebral vasospasm. The management of cerebral vasospasm after AVM rupture is discussed. (C) 1999 by Elsevier Science Inc.