Intra-arterially Administered Papaverine for the Treatment of Symptomatic Cerebral Vasospasm

Abstract

Although isolated series documenting clinical successes have prompted the increased use of papaverine as a treatment for vasospasm after SAH, this series suggests that, as it is currently being used, the drug does not provide added benefits, compared with medical treatment of vasospasm alone. This result does not preclude the possibility that alterations in the timing of or indications for drug treatment might produce beneficial effects.

Intra-Arterial Nimodipine for Severe Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Influence on Clinical Course and Cerebral Perfusion

“…17,21 However, clinical trials have failed to demonstrate the effectiveness of intra-arterial papaverine on outcome. 22 The most likely reason for this failure is the short duration of effect that has been documented: it is limited to a mere few hours. 23 Intra-arterial nimodipine (IAN) in patients with severe vasospasm has been reported by several authors.…”

Cerebral Aneurysms

“…Since angioplasty is not effective in dilating the distal arteries, superselective intra-arterial papaverine administration was proposed as an alternative or adjunctive method of treatment (40). Subsequently, the use of intra-arterial papaverine has been found to not provide additional benefits when compared with the medical treatment of vasospasm alone (68). Studies comparing the effects of transluminal angioplasty with intra-arterial papaverine have found angioplasty to be superior in reversing DID and in improving CBF (11,14).…”

Perspectivas en el tratamiento del vasospasmo cerebral inducido por hemorragia subaracnoidea

“…En nuestra experiencia, la angioplastia farmacológica PPV produce un mejoramiento rápido de la oxigenación cerebral medida en términos de saturación de oxígeno en el bulbo de la vena yugular interna 15 . Aunque un análisis retrospectivo multicéntrico no mostró beneficios de esta [16][17][18][19][20][21][22][23][24][25][26][27] 59 , a nuestro modo de ver, la PPV intraluminal sigue siendo una herramienta importante en el tratamiento del VC siempre y cuando sea apoyada por una terapia triple H intensiva antes, durante y después del tratamiento 17 .…”