Complications on intraarterial infusion of papaverine for the treatment of cerebral vasospasm

We have treated 92 vascular territories in 48 patients with symptomatic vasospasm after subarachnoid hemorrhage (SAH) using intraarterial infusion of papaverine and transient or permanent neurological deficits due to the infusion of papaverine occurred in 10 patients. By means of analyzing these 10 neurological complications due to the infusion of papaverine, we discussed the problem on papaverine treatment. Since highly concentrated papaverine of more than 0.4 % (weight/volume) had a higher risk of neurological deterioration, appropriate attention to the papaverine concentration may help decrease the incidence of side effects and the papaverine concentration of 0.4 % (w/v) infused at the top of the internal carotid artery (ICA) may be a safe and adequate concentration. However, the infusion of 0.4 % (w/v) papaverine is not always effective in any symptomatic cerebral vasospasm. In case the infusion of adequate papaverine concentration has few influences on cerebral vasospasm, we should take balloon angioplasty as well as the infusion of papaverine into consideration.