title: Endovascular treatment for symptomatic cerebral vasospasm after subarachnoid hemorrhage: transluminal balloon angioplasty compared with intraarterial papaverine.
abstract: The authors retrospectively evaluated the short-term neurological improvement of 69 patients undergoing endovascular treatment for symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). The patient group observed here is a subset of patients enrolled in the multicenter North American Trial of Tirilazad in SAH. Thirty-one patients were treated with intraarterial administration of papaverine (IAP). Fourteen patients were only treated with transluminal balloon angioplasty (TBA), and 24 patients received a combination of angioplasty and papaverine. The purpose of this study was to compare the effects of IAP and TBA on short-term clinical improvement of patients. Daily clinical staging with the modified Glasgow Coma Scale and every-other-day transcranial Doppler (TCD) measurements allowed for a close investigation of the clinical course. Furthermore, this study was designed to investigate the effects of treatment timing on short-term outcome. Although TCD studies demonstrated a decrease in flow velocities in the middle cerebral artery in both treatment groups, indicating a vasodilating effect of both treatment modalities (dv = -18.4 cm/second for papaverine, dv = -26.04 cm/second for angioplasty; p = 0.5509), there was no significant difference in clinical improvement at Days 1 and 4 postprocedure (p = 0.1996). Neither of the two treatment forms showed an effect of therapy timing on neurological outcome. Neither IAP nor TBA was correlated with a high percentage of short-term neurological improvement. The authors discuss reasons why those procedures may result in limited clinical change.
authors.affiliation: Medical Faculty, University of Technology, Aachen, Germany; Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, Virginia; Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio; and Department of Neurosurgery, Louisiana State University Medical Center, Shreveport, Louisiana.
authors.forename: V A
authors.initials: VA
authors.lastname: Coenen
authors.forename: C A
authors.initials: CA
authors.lastname: Hansen
authors.forename: N F
authors.initials: NF
authors.lastname: Kassell
authors.forename: R S
authors.initials: RS
authors.lastname: Polin