Abstract
For the last several years, we have been treating vesospasm with a combination therapy of intravenous highdosage nicardipine and an intraarterial infusion of papaverine (IAP). In some cases, we have gotten satisfactory results from IAP, but in other cases, the results have been less favorable. In order to determine the predictive factors of our results, we performed a retrospective study of cerebral circulation before and after IAP based upon dynamic DSA. Eighty-four patients with a diagnosis of ruptured intracranial aneurysm were treated with prophylactic nicardipine therapy. Twenty-eight of these 84 patients underwent IAP for symptomatic vasospasm. In 19 of these 28 patients, the mean transit time (MTT) based upon dynamic DSA data was extrapolated by gamma formula before and after papaverine infusion. The MTTs of the control group were 4.53±0.21 (mean±SD) seconds on the right hemisphere and 4.70±0.42 seconds on the left side. The MTTs of group A, for which IAP therapy showed a dramatic effect, were 5.20±0.54 seconds before IAP and 4.15±0.35 seconds after. Those of group B, for which IAP therapy showed a fair effect, were 5.56±0.71 seconds and 4.31±0.60 seconds, respectively. Those of group C, for which IAP therapy showed no effect, were 6.71±1.62 seconds and 4.63±0.38 seconds respectively. The MTTs before IAP were significantly longer in group C than in group A (p<0.05). In all cases, IAP therapy improved cerebral circulation based upon dynamic DSA study (p<0.01). But the shortening of MTTs after IAP therapy dose not always guarantee the good clinical results. Better clinical results may be expected the shorter the MTT velues before IAP therapy.
