Effect of intraarterial papaverine and/or angioplasty on the cerebral veins in patients with vasospasm after subarachnoid hemorrhage due to ruptured intracranial aneurysms.

Abstract

OBJECT: The goal in this study was to determine if there was a change in intracranial venous diameters after endovascular treatment of carotid distribution vasospasm caused by subarachnoid hemorrhage. METHODS: The venous diameters were measured in all patients who received intraarterial papaverine and/or balloon angioplasty for treatment of vasospasm during the study period of 3 years. To evaluate the veins of Labbe and Trolard, the straight sinus, and the superior sagittal sinus (SSS), measurements were performed in a blinded manner with the aid of a magnification loupe. Predetermined sites were evaluated on angiograms obtained before and after endovascular treatment. Forty-three treatments in 26 patients were included: 18 patients (33 territories) were treated with intraarterial papaverine alone, four (four territories) were treated with balloon angioplasty alone, and four (six territories) were treated with both papaverine infusion and angioplasty. The mean measured venous diameters increased significantly after addition of papaverine (10.9%), and also after combined papaverine and angioplasty (4.2%). There was no statistically significant increase in the mean venous diameters after angioplasty alone. If the initial intracranial pressure (ICP) was less than 15 mm Hg before treatment, the veins showed a greater tendency to dilate than if the initial ICP measurements were greater than 15 mm Hg. The straight sinus and the SSS increased more in diameter than the veins of Labbe and Trolard. There was no statistically significant correlation between the change in venous diameters with treatment and ICP. CONCLUSIONS: Endovascular treatment produces measurable increases in intracranial venous diameters. However, these changes do not correlate with changes in ICP.