Intra-arterial Administration of Papaverine during Mechanical Thrombectomy for Acute Ischemic Stroke

• Published in: Journal of stroke and cerebrovascular diseases 2015, Vol.24 (1), p.41-47
• Main Authors: Baltsavias, Gerasimos, MD, Yella, Susmitha, MD, Al Shameri, Rahman Abdul, MD, Luft, Andreas, MD, Valavanis, Anton, MD
• Format: Article
• Language: English
• Subjects: Acute ischemic stroke; Aged; Brain Ischemia - drug therapy; Brain Ischemia - therapy; Cardiovascular; Combined Modality Therapy; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Infusions, Intra-Arterial; Male; mechanical thrombectomy; Mechanical Thrombolysis - methods; Middle Aged; Neurology; papaverine; Papaverine - administration & dosage; Papaverine - therapeutic use; Retrospective Studies; stent retriever; Stroke - drug therapy; Stroke - therapy; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; vasospasm; Vasospasm, Intracranial - drug therapy
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.052

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.