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Disruption of the blood-brain barrier by intra-arterial administration of papaverine: a technical note

Platz, Johannes ; Baráth, Krisztina ; Keller, Emanuela ; Valavanis, Anton

In: Neuroradiology, 2008, vol. 50, no. 12, p. 1035-1039

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    Titre
    • Disruption of the blood-brain barrier by intra-arterial administration of papaverine: a technical note
    Auteur
    • Platz, Johannes. Institute of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
    • Baráth, Krisztina. Institute of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
    • Keller, Emanuela. Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland
    • Valavanis, Anton. Institute of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:319974
    Summary
    Introduction: Various endovascular techniques can be used to treat cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH) including intra-arterial administration of vasodilator drugs such as papaverine or nicardipine and balloon dilatation of the affected vessel segment. Papaverine is known to have side effects, and we report a possible new one. Materials and methods: After the treatment of cerebral vasospasm in a SAH patient by intra-arterial administration of papaverine into the left posterior cerebral artery, severe mesencephalic extravasation of blood and contrast media was detected. Results: After reviewing the literature, the authors conclude that interruption of the blood-brain barrier by papaverine most likely combined with a secondary hyperperfusion phenomena, and perhaps a direct toxic effect on brain tissue was the mechanism of this major complication. Conclusion: In treating vasospasm in areas with a high density of perforating arteries, especially in the posterior circulation, papaverine should be used cautiously because a safe regimen has yet to be established. In this situation, alternative agents such as calcium channel blockers could be considered, but evidence-based data are still missing