Acta Neurochirurgica

, Volume 135, Issue 3–4, pp 186–190 | Cite as

Intra-arterial infusion of papaverine combined with intravenous administration of high-dose nicardipine for cerebral vasospasm

  • S. Yoshimura
  • T. Tsukahara
  • N. Hashimoto
  • K. Kazekawa
  • A. Kobayashi
Clinical Articles


The clinical effect of combination therapy with high doses of intravenous nicardipine and intra-arterial infusion of papaverine on symptomatic vasospasm after subarachnoid haemorrhage (SAH) was analysed retrospectively. In 66 of 122 patients who underwent early aneurysm surgery between 1990 and 1993, the intracranial haemodynamics were documented by transcranial Doppler (TCD) ultrasonography. 33 of these 66 patients received high dose nicar-dipine intravenously (Group I); the other 33 patients were not treated with calcium antagonists (Group II). Symptomatic vasospasm occurred in 6 Group I patients (18%) and in 13 (39%) in Group II patients. All 19 symptomatic patients received an intra-arterial infusion of papaverine; 15 patients (79%) responded well to this therapy and the symptoms were reversed quickly. Although the mean flow velocity (MFV) was not different between the two groups, it was reduced significantly after papverine infusion.

Our retrospective analysis suggests that symptomatic vasospasm can be treated effectively with the combination of intravenous high dose nicardipine and intra-arterial infusion of papaverine, and that the correct timing of the infusions is crucial.


Cerebral vasospasm nicardipine papaverine subarachnoid haemorrhage 


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  1. 1.
    Alasdair JG, Bevan JA (1993) Flow-induced relaxation of the rabbit middle cerebral artery is composed of both endothelium-dependent and -independent components. Stroke 24: 105–110PubMedGoogle Scholar
  2. 2.
    Bevan JA, Joyce EH (1990) Flow-induced resistance artery tone: balance between constrictor and dilator mechanisms. Am J Physiol (Heart Circ Physiol 27) 258: 663–668Google Scholar
  3. 3.
    Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9PubMedGoogle Scholar
  4. 4.
    Flamm ES, Adams HP, Beck DW (1988) Dose-escalation study of intravenous nicardipine in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 68: 393–400PubMedGoogle Scholar
  5. 5.
    Frazee JG, Bevan JA, Bevan RD (1985) Effect of diltiazem on experimental chronic vasospasm in the monkey. J Neurosurg 62: 912–917PubMedGoogle Scholar
  6. 6.
    Grosset DG, Straiten J, McDonald I (1993) Use of transcranial Doppler sonography to predict development of a delayed ischemic neurological deficit after subarachnoid hemorrhage. J Neurosurg 78: 183–187PubMedGoogle Scholar
  7. 7.
    Haley EC Jr, Kassell NF, Torner JC (1993) A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. J Neurosurg 78: 537–547PubMedGoogle Scholar
  8. 8.
    Haley EC Jr, Kassell NF, Torner JC (1993) A randomized trial of nicardipine in subarachnoid hemorrhage; angiographic and transcranial Doppler ultrasound results. J Neurosurg 78: 548–553PubMedGoogle Scholar
  9. 9.
    Harders AG, Gilsbach JM (1987) Time course of blood velocured by transcranial Doppler ultrasound. J Neurosurg 66: 718–728PubMedGoogle Scholar
  10. 10.
    Higashida RT, Halbach VV, Leslie D (1989) Transluminal angioplasty for treatment of intracranial arterial vasospasm. J Neurosurg 71: 648–653PubMedGoogle Scholar
  11. 11.
    Kaku Y, Yonekawa Y, Tsukahara T (1992) Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77: 842–847PubMedGoogle Scholar
  12. 12.
    Kassell NF, Sasaki T, Colohan ART (1985) Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 14: 562–572Google Scholar
  13. 13.
    Krueger C, Wier B, Nosko M (1985) Nimodipine and chronic vasospasm in monkeys: part 2. Pharmacological studies of vessels in spasm. Neurosurgery 16: 137–140PubMedGoogle Scholar
  14. 14.
    Kuwayama A, Zervas NT, Shintani A (1972) Papaverine hydrochloride and experimental hemorrhagic cerebral arterial spasm. Stroke 3: 27–33PubMedGoogle Scholar
  15. 15.
    Masahiro O, Marshall BM, Lougheed WM (1973) Observations on the effects of intrathecal papaverine in experimental vasospasm. J Neurosurg 38: 20–25PubMedGoogle Scholar
  16. 16.
    Miyamoto M, Takayanagi I, Ohkuba H (1976) Actions of papaverine on intestinal smooth muscle and ints inhibition of cyclic AMP and cyclic GMP phosphodiesterases. Jpn J Pharmacol 26: 114–117Google Scholar
  17. 17.
    Newell DW, Eskridge JM, Mayberg MR (1989) Angioplasty for the treatment of symptomatic vasospasm following subarachnoid haemorrhage. J Neurosurg 71: 654–660PubMedGoogle Scholar
  18. 18.
    Pasqualin A, Tsukahara T, Kassell NF (1992) Effect of nicardipine on basilar artery vasoactive responses after subarachnoid hemorrhage. Neurosurgery 31: 697–704PubMedGoogle Scholar
  19. 19.
    Tsukahara T, Arista A, Kassell NF (1989) The distribution of intravenous nicardipine in rat brain after subarachnoid hemorrhage. Surg Neurol 32: 188–194PubMedGoogle Scholar
  20. 20.
    Zubkov YN, Nikiforov BM, Shustin VA (1984) Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien) 70: 65–79Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • S. Yoshimura
    • 1
  • T. Tsukahara
    • 1
  • N. Hashimoto
    • 1
  • K. Kazekawa
    • 1
  • A. Kobayashi
    • 1
  1. 1.Department of NeurosurgeryNational Cardiovascular CentreOsakaJapan

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