Disruption of the blood-brain barrier by intra-arterial administration of papaverine: a technical note.
BACKGROUND
Various endovascular techniques can be used to treat cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH) including intra-arterial administration of vasodilator drugs such as papaverine or nicardipine and balloon dilatation of the affected vessel segment. Papaverine is known to have side effects, and we report a possible new one.


METHODS
After the treatment of cerebral vasospasm in a SAH patient by intra-arterial administration of papaverine into the left posterior cerebral artery, severe mesencephalic extravasation of blood and contrast media was detected.


RESULTS
After reviewing the literature, the authors conclude that interruption of the blood-brain barrier by papaverine most likely combined with a secondary hyperperfusion phenomena, and perhaps a direct toxic effect on brain tissue was the mechanism of this major complication.


CONCLUSIONS
In treating vasospasm in areas with a high density of perforating arteries, especially in the posterior circulation, papaverine should be used cautiously because a safe regimen has yet to be established. In this situation, alternative agents such as calcium channel blockers could be considered, but evidence-based data are still missing.
Platz
Johannes
J
Institute of Neuroradiology, University Hospital Zürich, Zurich, Switzerland. platz@med.uni-frankfurt.de
Baráth
Krisztina
K
Keller
Emanuela
E
Valavanis
Anton
A
D000368:Aged; D001812:Blood-Brain Barrier / Q000187:drug effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D010208:Papaverine / Q000009:adverse effects* / Q000493:pharmacokinetics*; D020769:Posterior Cerebral Artery; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000493:pharmacokinetics*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
D014665:Vasodilator Agents; D010208:Papaverine
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