title: Effectiveness of papaverine cisternal irrigation for cerebral vasospasm after aneurysmal subarachnoid hemorrhage and measurement of biomarkers.
abstract: Cisternal irrigation with thrombolytic agents was used to prevent post-SAH vasospasm, but its role remained inconclusive. To verify effectiveness of papaverine (PPV) in preventing vasospasm, we studied relationship between inflammatory biologic markers and vasospasm. This prospective study included 121 patients with clipped anterior circulation aneurysms that had ruptured, and 372 control patients. Patients were divided into three groups according to cisternal irrigation method: simple drain, papaverine group, and urokinase (UK) group. Intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were determined in CSF and serum on days 3 and 7 after SAH. The PPV group showed similar incidence of vasospasm with UK group, but lower incidence than the simple drain group. The levels of ICAM-1 and VCAM-1 were significantly higher in the SAH group than in the control group. CSF and serum levels were more elevated on day 7 than day 3, and the degree of elevation were more marked when measured in the CSF than in the serum. However, there was no statistical difference between measured levels of ICAM-1 and VCAM-1, and vasospasm development. PPV cisternal irrigation was similarly effective as UK at preventing vasospasm. Although neither PPV nor UK irrigation could reduce the concentration of adhesion molecules compared with simple drain, we found levels of ICAM-1 and VCAM-1 were specifically elevated in the CSF. Therefore, further research should focus on anti-inflammation as a therapeutic target against cerebral vasospasm and on the CSF as the optimum place where such inflammatory action practically brought about.
authors.affiliation: Department of Neurosurgery, Eulji University Hospital, Seoul, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyeong-Joong
authors.initials: HJ
authors.lastname: Yi
authors.forename: Yong
authors.initials: Y
authors.lastname: Ko
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Kim
authors.forename: Jae-Min
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D000075982:Cell Adhesion Molecule-1; D015815:Cell Adhesion Molecules / Q000097:blood / Q000134:cerebrospinal fluid; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007136:Immunoglobulins / Q000097:blood / Q000134:cerebrospinal fluid; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000627:therapeutic use*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D007507:Therapeutic Irrigation / Q000009:adverse effects; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000097:blood / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C403514:CADM1 protein, human; D000075982:Cell Adhesion Molecule-1; D015815:Cell Adhesion Molecules; D005343:Fibrinolytic Agents; C573420:ICAM1 protein, human; D007136:Immunoglobulins; D018799:Intercellular Adhesion Molecule-1; D010208:Papaverine; D014568:Urokinase-Type Plasminogen Activator