Brain SPECT and transcranial Doppler (TCD) evaluation of the effects of intra-arterial papaverine for cerebral vasospasm
- Univ. of Washington School of Medicine, Seattle, WA (United States); and others
Cerebral vasospasm (cv) is a common and serious consequence of subarachnoid hemorrhage. Interventional neuroradiologic techniques for treating cv refractory to medical and hemodynamic measures have included transluminal microballoon angioplasty and intra-arterial papaverine infusion (pap). Eight patients (pts) who had symptomatic cv but were not candidates for microballoon angioplasty received pap via arterial catheter. All 8 pts had brain SPECT with Tc-99m HMPAO and 7 had TCD readings before and after treatment. One pt had 2 separate treatments. Total treatments = 9. Results: Of the total of 9 treatments: 5 demonstrated marked improvement in regional cerebral blood flow on SPECT in the vascular territories that were ischemic, 3 showed mild to moderate improvement of blood flow, and 1 was unchanged. The pt that did not improve on SPECT died due to cardiorespiratory problems but remained comatose without neurologic improvement after the treatment. The other 8 had either prompt clinical improvement or modestly delayed improvement due to concomitant hydrocephalus. infection, recurrent vasospasm or other intervening medical problems. TCD readings in the treated vessels showed improved (lower) velocities that agreed with SPECT improvement after 4 intra-arterial pap treatments. There were 4 discrepancies of SPECT and TCD: 1 with rising TCD velocity in the mild cv range in the treated vessel that demonstrated SPECT improvement; 1 with unchanged velocity in the moderate cv range that showed SPECT improvement; 1 that showed lower velocity in the moderate cv range while the SPECT was unchanged; and 1 that had normal TCD velocities before and after treatment but high pulsatility indices on Doppler (which are characteristic of either elevated intra-cranial pressure or distal vessel disease) who had mild to moderate improvement of blood flow on SPECT after treatment.
- OSTI ID:
- 197931
- Report Number(s):
- CONF-940605-; ISSN 0161-5505; TRN: 95:007029-0066
- Journal Information:
- Journal of Nuclear Medicine, Vol. 35, Issue Suppl.5; Conference: 41. annual meeting of the Society of Nuclear Medicine, Orlando, FL (United States), 5-8 Jun 1994; Other Information: PBD: May 1994
- Country of Publication:
- United States
- Language:
- English
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