Abstract
Introduction
Cerebral vasospasm (CV) remains a major cause of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). Here, we examined the effectiveness and safety of intra-arterial injection of colforsin daropate hydrochloride (CDH).
Methods
A consecutive series of 29 patients with angiographically confirmed CV received intra-arterial CDH (IAC) therapy. Angiographic changes in spastic vessels and the cerebral circulation time (CCT) were assessed before and after IAC treatment, together with the change in clinical status.
Results
IAC treatment was performed in 53 procedures in 29 patients. Angiographic improvement was observed following all procedures (100%), and clinical improvement was observed following 36 of 42 procedures (86%) in symptomatic cases. CCT improved significantly. At the 3-month follow-up, 19 patients (66%) showed good recovery or moderate disability on the Glasgow Outcome Scale. Major adverse effects were headache and increased heart rate.
Conclusions
IAC treatment was effective and safe for the treatment of CV after SAH
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Macdonald RL (2006) Management of cerebral vasospasm. Neurosurg Rev 29:179–193
Eskridge JM, Song JK (1997) A practical approach to the treatment of vasospasm. Am J Neuroradiol 18:1653–1660
Hosono M, Takahira T, Fujita A, Fujihara R, Ishizuka O, Tatee T, Nakamura K (1992) Cardiovascular and adenylate cyclase stimulant properties of NKH477, a novel water-soluble forskolin derivative. J Cardiovasc Pharmacol 19(4):625–634
Shafiq J, Suzuki S, Itoh T, Kuriyama H (1992) Mechanisms of vasodilation induced by NKH477, a water-soluble forskolin derivative, in smooth muscle of the porcine coronary artery. Circ Res 71:70–81
Aaslid R, Huber P, Nomes H (1984) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60:37–41
Suzuki S, Ito O, Sayama T, Yamaguchi S, Goto K, Sasaki T (2006) Intraarterial injection of colforsin daropate hydrochloride for the treatment of vasospasm after aneurysmal subarachnoid hemorrhage: preliminary report of two cases. Neuroradiology 48:50–53
Kaku Y, Yonekawa Y, Tsukahara T, Kazekawa K (1992) Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77:842–847
Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS (1992) Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 77:848–852
Smith WS, Dowd CF, Johnston SC, Ko NU, DeArmond SJ, Dillon WP, Setty D, Lawton MT, Young WL, Higashida RT, Halbach VV (2004) Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 35:2518–2522
Yoshimura S, Hashimoto N, Goto Y, Sampei K, Tsukahara T, Iihara K (1996) Intraarterial infusion of high-concentration papaverine damages cerebral arteries in rats. Am J Neuroradiol 17:1891–1894
Polin RS, Hansen CA, German P, Chadduck JB, Kassell NF (1998) Intra-arterially administered papaverine for the treatment of symptomatic cerebral vasospasm. Neurosurgery 42:1256–1267
Biondi A, Ricciardi GK, Puybasset L, Abdennour L, Longo M, Chiras J, Van Effenterre R (2004) Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. Am J Neuroradiol 25:1067–1076
Tachibana E, Harada T, Shibuya M, Saito K, Takayasu M, Suzuki Y, Yoshida J (1999) Intra-arterial infusion of fasudil hydrochloride for treating vasospasm following subarachnoid hemorrhage. Acta Neurochir 141:13–19
Tanaka K, Minami H, Kota M, Kuwamura K, Kohmura E (2005) Treatment of cerebral vasospasm with intra-arterial fasudil hydrochloride. Neurosurgery 56:214–223
Arakawa Y, Kikuta K, Hojo M, Goto Y, Ishii A, Yamagata S (2001) Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases. Neurosurgery 48:723–730
Yoshida K, Watanabe H, Nakamura S (1997) Intraarterial injection of amrinone for vasospasm induced by subarachnoid hemorrhage. Am J Neuroradiol 18:492–496
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suzuki, S., Ito, O., Sayama, T. et al. Intra-arterial colforsin daropate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Neuroradiology 52, 837–845 (2010). https://doi.org/10.1007/s00234-009-0631-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-009-0631-7