INTRAARTERIALLY ADMINISTERED PAPAVERINE FOR THE TREATMENT OF SYMPTOMATIC CEREBRAL VASOSPASM

OBJECTIVE: We examined the therapeutic benefits of intra-arterially ad ministered papaverine for treatment of symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH). Recent advances in microcatheter technology have facilitated endovascular approaches to vessels experie ncing vasospasm after SAH. However, despite numerous encouraging anecd otal reports, no rigorous examination of the efficacy of these procedu res has been published. Intra-arterial infusion of papaverine has beco me part of the standard management of vasospasm at some centers. METHO DS: We examined a series of 31 patients undergoing papaverine infusion for the treatment of symptomatic vasospasm after SAH. The patients we re a subgroup of the series enrolled in the North American Trial of Ti rilizad for Aneurysmal Subarachnoid Hemorrhage. These individuals were matched with patients from the same trial who exhibited similar clini cal characteristics (including the degree of vasospasm and the modifie d Glasgow Coma Scale scores measured at the time of admission and on t he day of papaverine infusion) but received medical management alone f or vasospasm. RESULTS: Logistic regression analysis comparing these tw o groups showed no statistical difference in the 3-month Glasgow Outco me Scale scores between patients receiving papaverine and control subj ects (58% favorable outcomes for control subjects versus 45% for patie nts receiving papaverine). CONCLUSION: Although isolated series docume nting clinical successes have prompted the increased use of papaverine as a treatment for vasospasm after SAH, this series suggests that, as it is currently being used, the drug does not provide added benefits, compared with medical treatment of vasospasm alone. This result does not preclude the possibility that alterations in the timing of or indi cations for drug treatment might produce beneficial effects.