title: Intra-arterial administration of papaverine during mechanical thrombectomy for acute ischemic stroke.
abstract: BACKGROUND
  The use of stent retrievers for mechanical thrombectomy in acute ischemic stroke may induce significant vasospasm, which at the early phases of reperfusion may be crucial for rethrombosis of the recanalized vessel. We aimed to study whether the use of intra-arterial papaverine in selected cases of vasospasm was associated with improved cerebral perfusion, arterial reocclusion, or increased hemorrhagic complications.
  
  
  METHODS
  We retrospectively studied 9 consecutive patients with large artery acute occlusion, treated with stent retriever and intra-arterial papaverine. Onset to administration of intravenous recombinant tissue-plasminogen activator time, baseline National Institute of Health Stroke Scale, time to reperfusion, number of passes of the stent retriever, modified Rankin Scale score at discharge, postprocedural hemorrhage, onset to reperfusion time, papaverine dose, and thrombolysis in cerebral infarction grade were recorded in all patients.
  
  
  RESULTS
  After papaverine administration, the caliber of the infused arteries and their flow was increased in all cases. In none of the treated cases a reocclusion occurred after papaverine infusion. In one of the studied patients (11%), a parenchymal bleeding occurred 36 hours postoperatively.
  
  
  CONCLUSIONS
  This small study suggests that intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after mechanical thrombectomy in acute ischemic stroke is effective and safe.
authors.affiliation: Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: Gerasimos.Baltsavias@usz.ch.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Baltsavias
authors.affiliation: Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Susmitha
authors.initials: S
authors.lastname: Yella
authors.affiliation: Department of Neurosurgery, Ch. Doppler Medical Center, Salzburg, Austria.
authors.forename: Rahman Abdul
authors.initials: RA
authors.lastname: Al Shameri
authors.affiliation: Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Luft
authors.affiliation: Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Anton
authors.initials: A
authors.lastname: Valavanis
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000188:drug therapy
chemical_list: D005343:Fibrinolytic Agents; D014665:Vasodilator Agents; D010208:Papaverine; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; mechanical thrombectomy; papaverine; stent retriever; vasospasm