Intra-Arterial Papaverine for the Treatment of Cerebral Vasospasm

Summary

Cerebral vasospasm continues to be the leading treatable cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. In this preliminary anecdotal series of 15 patients who were candidates for balloon angioplasty, vasospasm was treated instead with intra-arterial papaverine. Ten patients had marked angiographic reversal of the arterial narrowing following the papaverine infusion. Five of these patients showed dramatic reversal of profound neurologic deficits following papaverine treatment. Two patients clinically deteriorated five days after the initial successful papaverine infusions. In both, repeat angiograms demonstrated severe recurrent vasospasm which was partially reversed with a second intra-arterial papaverine treatment. Three patients developed focal neurologic deficits during papaverine infusion which spontaneously resolved over several hours after cessation of the intraarterial infusion. Arterial narrowing in the posterior circulation and middle cerebral artery distribution appeared to be more responsive to papaverine infusion than spasm in the anterior cerebral arteries. The infusion of 300 mg of papaverine over one hour seemed to be an adequate and safe dose to effect these angiographie and clinical improvements.

Presented in part at the Congress of Neurological Surgeons Orlando, Florida, 1991; and the American Association of Neurological Surgeons, New Orleans, Louisiana, 1991.