Distribution of Intraarterially Administered Papaverine in Endovascular Treatment of Delayed Cerebral Vasospasm

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The distribution of selectively administered papaverine was determined in nine patients with delayed cerebral vasospasm in the territories of the anterior (ACA) and/or middle cerebral arteries (MCA) secondary to aneurysmal subarachnoid hemorrhage by simultaneous infusion with technetium-99m-hex-amethyl-propyleneamine oxime (^lt99mgtTc-HMPAO). Four of the nine patients had a ruptured anterior communicating artery aneurysm, four had an internal carotid artery aneurysm, and the remaining one had a MCA aneurysm. Trapping of anterior communicating artery was carried out in one case and clipping of aneurysms in other eight cases. Neurological deterioration with hemiparesis, paraparesis, and/or somnolence appeared between postsurgical Days 8 and 13 due to delayed cerebral vasospasm in all patients. Intraarterial infusion of 40 mg of papaverine containing 37 MBq of ^lt99mgtTc-HMPAO was performed from the C_1 segment in seven of the nine patients and from the C_4 segment in the other two patients. ^lt99mgtTc-HMPAO was distributed in the territories of the ACA and MCA in the two patients who were treated with intraarterial infusion of papaverine from the C_4 segment, but was distributed only to the territory of the ACA in four patients who were treated with intraarterial infusion of papaverine from the C_1 segment at 1 ml/min. In contrast, ^lt99mgtTc-HMPAO was distributed in the territories of the ACA and MCA in the three patients who were treated with papaverine from the C_1 segment at 2 ml/min, although most ^lt99mgtTc-HMPAO was distributed in the territory of the ACA. Vasospasm of the ACA can be treated by intraarterial infusion of papaverine from the C_1 segment at 1 ml/min when selective catheterization to the ACA is difficult to perform.
日本脳神経外科学会の論文
1997-02-15

Distribution of Intraarterially Administered Papaverine in Endovascular Treatment of Delayed Cerebral Vasospasm

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