Clinical evaluation of the effect of percutaneous transluminal angioplastyand intra-arterial papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage

The clinical efficacy of percutaneous transluminal angioplasty and intra-ar terial papaverine infusion for treatment of vasospasm following subarachnoi d hemorrhage was investigated. Between 1990 and 1993, 84 patients were trea ted for cerebral vasospasm in National Defense Medical College Hospital. An gioplasty was performed for asymptomatic vasospasm in 18 patients and for s ymptomatic vasospasm in 12 patients. Intra-arterial papaverine infusion was performed for asymptomatic vasospasm in 10 patients and for symptomatic va sospasm in four patients. The other 40 patients were treated with standard conservative therapy including hypervolemic and hypertensive hemodilution. The outcomes of these patients were analyzed using the Glasgow Outcome Scal e. The outcome tended to be better for patients treated with angioplasty, b ut not for those treated with papaverine infusion, than for those treated c onservatively. Recurrence of vasospasm was more frequent after papaverine i nfusion than after angioplasty. Undesirable complications such as abrupt de velopment of unconsciousness were experienced during papaverine infusion bu t not during angioplasty. We conclude that percutaneous transluminal angiop lasty is superior to intra-arterial papaverine infusion for prevention and treatment of vasospasm following aneurysmal subarachnoid hemorrhage.