Intra-arterial Injection of Papaverine with/without Nicardipine for Treatment of Vasospasm Following Ruptured Cerebral Aneurysm

We assessed the effect of intra-arterial injection (IA) of Papaverine hydrochloride (Papaverine) with/without Ca++. antagonist (Nicardipine) on vasospasm following aneurysmal rupture.We carried out this investigation as an open study on 70 patients. The average age was 52.1 and all underwent early aneurysm surgery within 48 hours after onset of subarachnoid hemorrhage. IA was carried out after development of neurological symptoms due to vasospasm and/or rapid increase of intracranial blood flow velocity on transcranial Doppler sonography (TCD). Vasospasm was graded by the degree of narrowing of main cerebral arteries by reference to angiograms obtained before aneurysm surgery. Intra-arterial injection of Papaverine (40-240mg) with/without Nicardipine (5-10mg) was carried out through a catheter inserted into the C5 portion of the internal carotid artery. Response of spastic arteries to Papaverine with/without Nicardipine was assessed on angiograms before and after drug injections.The main cerebral arteries were all more or less dilated by IA therapy. When we compared the responses with IA among Day 4-5, Day 7-8, and later than Day 9 to examine the optimal timing of IA, the responses were most prominent in patients of Day 4-5, In most cases, however, efficacy of this therapy did not continue more than 24 hours: TCD usually showed increase of blood flow velocity of the cerebral arteries on the following day. However, only 11 cases required a second injection of drugs or angioplasty.IA of Papaverine with/without Nicardipine is a safe and easy method for treatment of vasospasm, and timing of IA is most important for this treatment.