Transluminal angioplasty and intra-arterial papaverine for the treatment of cerebral vasospasm after ruptured arteriovenous malformations

• Published in: Surgical neurology 1999, Vol.51 (1), p.75-80
• Main Authors: Zubkov, Alexander Y, Lewis, Adam I, Scalzo, David
• Format: Article
• Language: English
• Subjects: Adult; angioplasty; Angioplasty, Balloon; arteriovenous malformation; Cerebral Angiography; Cerebral vasospasm; Cerebrovascular Circulation - drug effects; Combined Modality Therapy; Female; Humans; Injections, Intra-Arterial; Intracranial Arteriovenous Malformations - complications; Intracranial Arteriovenous Malformations - diagnostic imaging; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - drug therapy; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - physiopathology; Ischemic Attack, Transient - therapy; Male; Middle Aged; papaverine; Papaverine - administration & dosage; Rupture, Spontaneous; Tomography, X-Ray Computed; Treatment Outcome; Vasodilator Agents - administration & dosage
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/S0090-3019(98)00031-7

BACKGROUND This is the first report on the use of intra-arterial papaverine and percutaneous transluminal angioplasty in two patients with severe, symptomatic cerebral vasospasm who suffered ruptured arteriovenous malformations (AVMs). CASE DESCRIPTIONS The source of hemorrhage was a venous aneurysm in the first case and a pedicular aneurysm of the distal posterior inferior cerebellar artery in the second case. In both cases, the AVMs were located in the superior vermis and there was minimal subarachnoid hemorrhage. The first patient underwent removal of the AVM before the period of cerebral vasospasm and the second patient underwent removal of the AVM after the cerebral vasospasm had resolved. The outcome was excellent in the first patient and poor in the second patient. CONCLUSION Arteriovenous malformation with ruptured aneurysms may be at high risk for cerebral vasospasm even when there is minimal subarachnoid hemorrhage. We recommend early treatment of AVMs with ruptured pedicular, intranidal, or venous aneurysms to avoid rebleeding and to allow for aggressive treatment of cerebral vasospasm. The management of cerebral vasospasm after AVM rupture is discussed.