Intra-arterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Firlik, Katrina S.; Kaufmann, Anthony M.; Firlik, Andrew D.; Jungreis, Charles A.; Yonas, Howard

doi:10.1016/s0090-3019(97)00370-4

Cited by 101 publications

(59 citation statements)

References 16 publications

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“…1,6 Topical application of PPV is known to have a dilating effect on cerebral arteries and arterioles. 7,8 In our study, however, PPV surprisingly did not elicit a microvascular response in control subjects. Contrary to these observations, in patients with SAH, variable arteriolar dilation was seen for only several minutes during the early course of SAH after which most microvessels returned to their baseline diameters.…”

Section: Discussioncontrasting

confidence: 74%

Abnormal Responses of the Human Cerebral Microcirculation to Papaverin During Aneurysm Surgery

Pennings

Albrecht

Muizelaar

et al. 2009

Stroke

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Background and Purpose-The role of the cerebral microcirculation in delayed ischemia after subarachnoid hemorrhage remains obscure. To test the hypothesis that cerebral arterioles have a reduced capacity to dilate after subarachnoid hemorrhage, we studied the microvascular responses to papaverine (PPV) in patients undergoing aneurysm surgery. Method-In 14 patients undergoing aneurysm surgery, the diameter changes of cortical microvessels after topical application of PPV were observed using orthogonal polarizing spectral imaging. Results-In control subjects, neither arterioles nor venules showed diameter changes in response to topical PPV. In patients operated Ͻ48 hours after subarachnoid hemorrhage, PPV resulted in vasodilatation of arterioles with 45Ϯ41% increase in arteriolar diameter (Pϭ0.012). In 2 of these patients, arteriolar diameter returned below baseline value. In patients undergoing late aneurysm clipping, the diameter increase of the arterioles after PPV was 25Ϯ24% (not significant). In 2 patients of this group, no vasodilatation but focal arteriolar narrowing occurred. Conclusions-In patients with subarachnoid hemorrhage, unpredictable response patterns to PPV were observed with "rebound" vasoconstriction suggesting increased contractility of the microcirculation. Yet, diminished vasodilatory capacity of the cerebral microcirculation after subarachnoid hemorrhage was not confirmed by this study. (Stroke. 2009; 40:317-320.)

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Section: Discussioncontrasting

confidence: 74%

Abnormal Responses of the Human Cerebral Microcirculation to Papaverin During Aneurysm Surgery

Pennings

Albrecht

Muizelaar

et al. 2009

Stroke

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“…For instance, patients treated with IA papaverine may still have further neurologic deterioration despite angiographic im- provement. 19 Conversely, patients treated with IA nimodipine may demonstrate remarkable clinical improvement despite unchanged angiographic vasospasm. 7 Similarly, IA infusion of L-arginine has been shown to markedly increase CBF in a primate model of SAH, despite the lack of any angiographic changes.…”

Section: Discussionmentioning

confidence: 99%

“…As an example, Firlik et al 19 have demonstrated that IA papaverine may fail to improve CBF despite reversal of angiographic vasospasm. These authors reported a series of 15 patients with symptomatic vasospasm who underwent a total of 23 IA papaverine treatments (including combined angioplasty on 5 occasions).…”

Section: Discussionmentioning

confidence: 99%

“…Pre-and posttreatment CBF was assessed by stable xenon-enhanced CT on 13 occasions but showed improvement in previously ischemic areas in only 6 of these (46%). 19 CTP has been shown to be a useful tool in the selection of proper candidates for acute stroke thrombolysis 21 and has more recently been used to diagnose and guide medical and endovascular therapy in patients with delayed cerebral ischemia after aSAH. 8,9,22 The application of CTP to assess the response to vasospasm treatment has also been previously reported.…”

Section: Discussionmentioning

confidence: 99%

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Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm

Nogueira¹,

Lev²,

Roccatagliata³

et al. 2008

AJNR Am J Neuroradiol

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“…13,14 Xenon-enhanced computed tomography scanning has been used to identify the presence of ischemia (defined by a CBF value Ͻ 20 ml/ 100 g/min) in patients with post-SAH vasospasm, and it has also been used to document improved CBF after medical or endovascular therapy. 12,15,45 S. P. Lad, et al 28 In the setting of carotid balloon test occlusion, Xe-CT scanning has been used to help identify patients in whom the balloon test occlusion is clinically successful but who have a CBF value less than 30 ml/100 g/min, placing them at increased risk for stroke. 20 Adding acetazolamide may help identify patients who exhaust their cerebrovascular reserve during the balloon test occlusion.…”

Section: The Xe-ct Modalitymentioning

confidence: 99%

Cerebral perfusion imaging in vasospasm

Lad¹,

Guzman²,

Kelly³

et al. 2006

FOC

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✓Vasospasm following cerebral aneurysm rupture is one of the most devastating sequelae and the most common cause of delayed ischemic neurological deficit (DIND). Because vasospasm also is the most common cause of morbidity and mortality in patients who survive the initial bleeding episode, it is imperative not only to diagnose the condition but also to predict which patients are likely to become symptomatic. The exact pathophysiology of vasospasm is complex and incompletely elucidated. Early recognition of vasospasm is essential because the timely use of several therapeutic interventions can counteract this disease and prevent the occurrence of DIND. However, the prompt implementation of these therapies depends on the ability to predict impending vasospasm or to diagnose it at its early stages. A number of techniques have been developed during the past several decades to evaluate cerebral perfusion, including positron emission tomography, xenon-enhanced computed tomography, single-photon emission computed tomography, perfusion- and diffusion-weighted magnetic resonance imaging, and perfusion computed tomography. In this article, the authors provide a general overview of the currently available perfusion imaging techniques and their applications in treating vasospasm after a patient has suffered a subarachnoid hemorrhage. The use of cerebral perfusion imaging techniques for the early detection of vasospasm is becoming more common and may provide opportunities for early therapeutic intervention to counteract vasospasm in its earliest stages and prevent the occurrence of DINDs.

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Intra-arterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Cited by 101 publications

References 16 publications

Abnormal Responses of the Human Cerebral Microcirculation to Papaverin During Aneurysm Surgery

Abnormal Responses of the Human Cerebral Microcirculation to Papaverin During Aneurysm Surgery

Intra-Arterial Nicardipine Infusion Improves CT Perfusion–Measured Cerebral Blood Flow in Patients with Subarachnoid Hemorrhage–Induced Vasospasm

Cerebral perfusion imaging in vasospasm

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