Multimodal quantitation of the effects of endovascular therapy for vasospasm on cerebral blood flow, transcranial doppler ultrasonographic velocities, and cerebral artery diameters.
OBJECTIVE
The goal of this study was to quantify the effects of endovascular therapy on vasospastic cerebral vessels.


METHODS
We reviewed the medical records for 387 patients with ruptured intracranial aneurysms who were treated at a single institution (University of California, Los Angeles) between May 1, 1993, and March 31, 2001. Patients who developed cerebral vasospasm and underwent cerebral arteriographic, transcranial Doppler ultrasonographic, and cerebral blood flow (CBF) studies before and after endovascular therapy for cerebral arterial spasm (vasospasm) were included in this study.


RESULTS
Forty-five patients fulfilled the aforementioned criteria and were treated with either papaverine infusion, papaverine infusion with angioplasty, or angioplasty alone. After balloon angioplasty (12 patients), CBF increased from 27.8 +/- 2.8 ml/100 g/min to 28.4 +/- 3.0 ml/100 g/min (P = 0.87); the middle cerebral artery blood flow velocity was 1 57.6 +/- 9.4 cm/s and decreased to 76.3 +/- 9.3 cm/s (P < 0.05), with a mean increase in cerebral artery diameters of 24.4%. Papaverine infusion (20 patients) transiently increased the CBF from 27.5 +/- 2.1 ml/100 g/min to 38.7 +/- 2.8 ml/100 g/min (P < 0.05) and decreased the middle cerebral artery blood flow velocity from 109.9 +/- 9.1 cm/s to 82.8 +/- 8.6 cm/s (P < 0.05). There was a mean increase in vessel diameters of 30.1% after papaverine infusion. Combined treatment (13 patients) significantly increased the CBF from 33.3 +/- 3.2 ml/100 g/min to 41.7 +/- 2.8 ml/100 g/min (P< 0.05) and decreased the transcranial Doppler velocities from 148.9 +/- 12.7 cm/s to 111.4 +/- 10.6 cm/s (P < 0.05), with a mean increase in vessel diameters of 42.2%.


CONCLUSIONS
Balloon angioplasty increased proximal vessel diameters, whereas papaverine treatment effectively dilated distal cerebral vessels. In our small series, we observed no correlation between early clinical improvement or clinical outcomes and any of our quantitative or physiological data (CBF, transcranial Doppler velocities, or vessel diameters).
Division of Neurosurgery and Cerebral Blood Flow Laboratory, University of California, Los Angeles, School of Medicine, USA. rodjamshid@hotmail.com
Rod J
RJ
Oskouian
Neil A
NA
Martin
Jae Hong
JH
Lee
Thomas C
TC
Glenn
Donald
D
Guthrie
Nestor R
NR
Gonzalez
Arash
A
Afari
Fernando
F
Viñuela
D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data*; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply; D002533:Cerebral Angiography; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010208:Papaverine / Q000008:administration & dosage* / Q000009:adverse effects; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D017585:Ultrasonography, Doppler, Transcranial / Q000706:statistics & numerical data*; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*
D014665:Vasodilator Agents; D010208:Papaverine