Intra-arterial papaverine infusions for the treatment of cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage

  title={Intra-arterial papaverine infusions for the treatment of cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage},
  author={James K.C. Liu and William T. Couldwell},
  journal={Neurocritical Care},
Cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage that has become refractory to maximal medical management can be treated with selective intra-arterial papaverine infusions. Papaverine is a potent vasodilator of the proximal, intermediate, and distal cerebral arteries and can improve cerebral blood flow (CBF). When infused intra-arterially using endovascular microcatheter techniques, papaverine can effectively increase angiographic vessel diameter, decrease prolonged cerebral… 

Intra-arterial Dantrolene for Refractory Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Intra-arterial dantrolene induced a sustained improvement in cerebral vasospasm secondary to ruptured aneurysm, and a follow up cerebral angiogram after 1 day demonstrated the persistence of therapeutic effect.

Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage.

The authors review the current options in terms of endovascular therapies for treatment of cerebral vasospasm and the mechanism of action, technique of administration, clinical effect and outcomes, and complications of each modality are discussed.

Continuous Selective Intra-Arterial Application of Nimodipine in Refractory Cerebral Vasospasm due to Aneurysmal Subarachnoid Hemorrhage

Local continuous intra-arterial nimodipine treatment for refractory cerebral vasospasm after aSAH can be recommended as a low-risk treatment in addition to established endovascular therapies.

Continuous intra-arterial infusion of nimodipine at the onset of resistant vasospasm in aneurysmal subarachnoidal haemorrhage. Technical report

Four patients with severe aneurysmal subarachnoid haemorrhage and refractory vasospasms with continuous nimodipine infusion via catheters in both internal carotid arteries were treated and the efficacy of the method was discussed, presenting an illustrative case and discussing the effect based on doppler examinations.

The Impact of Intra-Arterial Papaverine-Hydrochloride on Cerebral Metabolism and Oxygenation for Treatment of Delayed-Onset Post-Subarachnoid Hemorrhage Vasospasm.

The initial detrimental effects of the endovascular procedure itself were outweighed by an improved cerebral metabolism within 10 h thereafter, and repeated interventions or continuous application should be considered.

Intra-arterial Nimodipine Combined with Intra-arterial Milrinone for the Treatment of Cerebral Vasospasm Following Subarachnoid Hemorrhage

Intra-arterial nimodipine along with milrinone was found to be effective in this case with severe cerebral vasospasm preoperatively which is rarely reported in the literature.

A Simplified Method for Administration of Intra-Arterial Nicardipine for Vasospasm With Cervical Catheter Infusion

In most patients, infusion can be performed from the cervical catheter, with microcatheter infusion and angioplasty reserved for the more severe and resistant cases, and intra-arterial nicardipine is an effective and safe treatment for cerebral vasospasm.

Milrinone as a Rescue Therapy for Symptomatic Refractory Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

This study indicates that high-dose intraarterial verapamil may be used to treat cerebral vasospasm without compromising hemodynamic stability or increasing ICP.

Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

  • W. ChoH. Kang M.H. Han
  • Medicine
    Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
  • 2011
Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH and showed satisfactory outcomes.



Treatment of cerebral vasospasm with intra-arterial papaverine.

In this preliminary anecdotal series of 12 patients who were candidates for balloon angioplasty, vasospasm was treated instead with intra-arterial papaverine, and marked angiographic reversal of the arterial narrowing following papaversine infusion and dramatic reversal of profound neurological deficits were shown.

Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage.

The successful treatment of cerebral vasospasm after subarachnoid hemorrhage with superselective intra-arterial infusion of papaverine hydrochloride and eight of 10 patients showed improvement in neurological function after the procedure.

Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm.

The preliminary results indicate that multiple intraarterial papaverine treatments consistently improve cerebral circulation times, even with repeated infusions in cases of recurrent vasospasm.

Intraarterial papaverine infusion for cerebral vasospasm after subarachnoid hemorrhage.

Papaverine was effective in dilating narrowed arteries in most patients with symptomatic vasospasm caused by subarachnoid hemorrhage with encouraging clinical results with no recurrence of neurologic deterioration in those patients who responded well to papaverine.

Intracranial pressure changes induced during papaverine infusion for treatment of vasospasm.

A careful, titrated infusion of papaverine, with constant reference to the patient's ICP, blood pressure, and pulse rate, minimizes the transient increase in ICP while maintaining adequate blood pressure and CPP.

Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage. Case report.

This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH, and possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

Repeat intra-arterial papaverine for recurrent cerebral vasospasm after subarachnoid haemorrhage

The preliminary results suggest that repeat papaverine infusion may be a way of controlling recurrent or recalcitrant vasospasm.

Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage

Test the hypothesis that balloon angioplasty is superior to papaverine infusion for the treatment of proximal anterior circulation arterial vasospasm following subarachnoid hemorrhage by comparing mean pre- and posttreatment velocity.