Intraarterial infusion of papaverine and change of cerebral hemodynamics in symptomatic cerebral vasospasm

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In 43 cases with symptomatic cerebral vasospasm after aneurysmal subarachnoidhemorrhage treated by intraarterial infusion of papaverine (IAP), we studied cerebralhemodynamics by measuring cerebral circulation time (CCT) using digital subtractionangiogram. CCT on the middle cerebral artery site was defined as CCT-LAV and onthe anterior cerebral artery side as CCT-MAV. In the CCT-LAV, two phases werefurther defined; the arterial phase (CCT-A) and the capillary phase (CCT-CAP). MeanCCT-LAV before and after IAP was 6.35 ± 1.69 sec, 4.91 ± 1.56 sec, and meanCCT-MAV was 6.15 ± 1.68 sec, 4.80 ± 1.58 sec, each showing a significant shortening.Mean CCT-A before and after IAP was 0.274 ± 0.105 sec, 0.226 ± 0.066 sec and meanCCT-CAP was 6.00 ± 1.62 sec and 4.60 ± 1.55 sec. The shortening rate of CCT-A andCCT-CAP were 11.2 ± 25.7% and 22.7 ± 14.6% respectively.Our study confirmed that IAP shortened CCT and improved cerebralhemodynamics. Compared with CCT-A, CCT-CAP was shortened significantly,suggesting that IAP is working not only in the proximal vessels but also in the distalvessels, that is, effective for resolution of vasospasm in the view of cerebralmicrocirculation. Clinical outcome was not improved statistically, however, it is the factthat there are not a few cases improved neurologically and IAP is still useful forvasospasm as a means to directly dilate intracranial peripheral arteries.
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