COMPARISON OF BALLOON ANGIOPLASTY AND PAPAVERINE INFUSION FOR THE TREATMENT OF VASOSPASM FOLLOWING ANEURYSMAL SUBARACHNOID HEMORRHAGE

Object. The purpose of this study was to test the hypothesis that ball oon angioplasty is superior to papaverine infusion for the treatment o f proximal anterior circulation arterial vasospasm following subarachn oid hemorrhage (SAH). Between 1989 and 1995, 125 vasospastic distal in ternal carotid artery or proximal middle cerebral artery vessel segmen ts were treated in 52 patients. Methods. Blood flow velocities of the involved vessels were assessed by using transcranial Doppler (TCD) mon itoring in relation to the day of treatment with balloon angioplasty o r papaverine infusion. Balloon angioplasty and papaverine infusion coh orts were compared based on mean pre-and posttreatment velocity at 24 and 48 hours using the one-tailed, paired-samples t-test. Balloon angi oplasty alone was performed in 101 vessel segments (81%) in 39 patient s (75%), whereas papaverine infusion alone was used in 24 vessel segme nts (19%) in 13 patients (25%). Although repeated treatment after ball oon angioplasty was needed in only one vessel segment, repeated treatm ent following papaverine infusion was required in 10 vessel segments ( 42%) in six patients because of recurrent vasospasm (p < 0.001). Seven vessel segments (29%) with recurrent spasm following papaverine infus ion were treated with balloon angioplasty. Although vessel segments tr eated with papaverine demonstrated a 20% mean decrease in blood flow v elocity (p < 0.009) on posttreatment Day 1, velocities were not signif icantly lower than pretreatment levels by posttreatment Day 2 (p = 0.1 33). Balloon angioplasty resulted in a 45% mean decrease in velocity t o a normal level following treatment (p < 0.001), a decrease that was sustained. Conclusions. Balloon angioplasty is superior to papaverine infusion for the permanent treatment of proximal anterior circulation vasospasm following aneurysmal SAH.