title: Intravascular infusion of lidocaine: a novel way to relieve sudden internal carotid artery occlusion in embolization of intracranial aneurysms.
abstract: BACKGROUND
  Sudden internal carotid artery (ICA) occlusive vasospasm is a serious complication of intracranial aneurysm embolization. Conventional spasmolysis with papaverine yields a generally poor outcome. We believe that arterial infusion of lidocaine may offer a better outcome.
  
  
  METHODS
  We retrospectively reviewed the outcome of patients treated with either papaverine or lidocaine infusion for vasospasm during embolization.
  
  
  RESULTS
  14 patients undergoing intracranial aneurysm embolization had a ICA occlusive vasospasm. Among the 8 patients who received conventional treatment with papaverine the vasospasm improved partially in 5. In 3 cases, treatment was ineffective. 6 of the patients died within 3 days. 2 patients developed hemispheric infarction and underwent a decompressive craniectomy and subtotal resection of the infarct; 1 of these 2 patients died after 4 months and the other was severely disabled. In the 6 patients treated with lidocaine, spasmolysis and subsequent aneurysm treatment was successful in 5. In 1 patient who had preoperative stenosis of the carotid artery proximal to the aneurysm spasmolysis failed.
  
  
  CONCLUSIONS
  ICA occlusive spasm is an extremely serious and often lethal complication in embolization of intracranial aneurysms. Conventional treatment with papaverine has a poor outcome, whereas arterial infusion of lidocaine may achieve better results.
authors.affiliation: The Affiliated People's Hospital of Jiangsu University, Department of Neurosurgery, Zhenjiang, China.
authors.forename: Qiao Yu
authors.initials: QY
authors.lastname: Li
authors.forename: Wen Lin
authors.initials: WL
authors.lastname: Xu
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Pej Shan
authors.initials: PS
authors.lastname: Lu
authors.forename: Zhi Cheng
authors.initials: ZC
authors.lastname: Yuan
authors.forename: Li Ping
authors.initials: LP
authors.lastname: Zhan
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.forename: Xia Yu
authors.initials: XY
authors.lastname: Lu
authors.forename: Bo
authors.initials: B
authors.lastname: Cheng
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000187:drug effects / Q000503:physiopathology; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D002532:Intracranial Aneurysm / Q000601:surgery / Q000628:therapy*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000627:therapeutic use; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D014665:Vasodilator Agents; D008012:Lidocaine; D010208:Papaverine