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

In 43 cases with symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage treated by intraarterial infusion of papaverine (IAP), we studied cerebral hemodynamics by measuring cerebral circulation time (CCT) using digital subtraction angiogram. CCT on the middle cerebral artery site was defined as CCT-LAV and on the anterior cerebral artery side as CCT-MAV. In the CCT-LAV, two phases were further defined; the arterial phase (CCT-A) and the capillary phase (CCT-CAP). Mean CCT-LAV before and after IAP was 6.35+/-1.69 sec, 4.91+/-1.56 sec, and mean CCT-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 mean CCT-CAP was 6.00+/-1.62 sec and 4.60+/-1.55 sec. The shortening rate of CCT-A and CCT-CAP were 11.2+/-25.7% and 22.7+/-14.6% respectively. Our study confirmed that IAP shortened CCT and improved cerebral hemodynamics. Compared with CCT-A, CCT-CAP was shortened significantly, suggesting that IAP is working not only in the proximal vessels but also in the distal vessels, that is, effective for resolution of vasospasm in the view of cerebral microcirculation. Clinical outcome was not improved statistically, however, it is the fact that there are not a few cases improved neurologically and IAP is still useful for vasospasm as a means to directly dilate intracranial peripheral arteries.