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Interventional Neuroradiology is a minimally invasive approach in the treatment of vascular diseases of the central nervous system. Conditions in the past that would have required surgical intervention such as aneurysms, vascular malformations, and tumors of the brain, spine, head and neck can be considered for treatment by using an endovascular approach to reach the lesion.
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[Functional and Stereotactic Neurosurgery][Cerebrovascular Surgery Center] Interventional Neuroradiology ~ Papaverine Therapy for Vasospasm
Intra-arterial Papaverine Therapy for Vasospasm: Does it Work?
Key Words: subarachnoid hemorrhage, vasospasm, papaverine
The Interventional Neuroradiology service at Massachusetts General Hospital
and the MGH Brain Aneurysm & AVM Center. 

Objectives:
Cerebral vasospasm following aneurysmal subarachnoid hemorrhage remains a significant problem among patients surviving aneurysm rupture. Intra-arterial papaverine infusion has been shown to have angiographic efficacy in relieving spasm and is presumed to prevent new strokes among these patients. The latter is unproven. The purpose of our study was to determine the CT incidence of vasospasm induced stroke following the initiation of intra-arterial papaverine therapy.

Methods: We reviewed the clinical, angiographic and CT data of all patients treated with intra-arterial papaverine therapy for cerebral vasospasm following aneurysmal subarachnoid hemorrhage between 12/93 and 6/97. All patients failed a trial of hemodynamic augmentation prior to consideration of papaverine therapy. Infusion was performed using microcatheter techniques and an infusion protocol similar that published previously. The numbers of procedures and of catheter infusion positions and the incidence of complications were recorded. Pre-treatment and long term follow-up head CTs were compared for the presence of new strokes.

Results: 35 patients were treated in 86 procedures (2.5/pt) using a total of 125 catheter positions (3.6/pt, 1.5/procedure). Two additional patients were excluded because pre- and post-treatment CTs were unavailable. The dose varied between 50 mg and 300 mg per catheter position. 4 patients underwent balloon angioplasty for spasm refractory to papaverine based on angiography. 14 patients (40%) developed new strokes following initiation of papaverine treatment, 21 (60%) did not. There were 5 complications related to papaverine therapy: 1 embolus resulting in a stroke and 4 dissections two of which contributed to the development of stroke. That is, the symptomatic complication rate associated with papaverine infusion was 3/35 = 8.6%.

Conclusions: A significant minority of patients treated with intra-arterial papaverine for cerebral vasospasm develop new strokes. Better therapies for this dreaded complication of subarachnoid hemorrhage are needed.

References:
    Kassell
    Kaku
    Cloughsey
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