Effect of intraarterial papaverine on cerebral circulation time.

PURPOSE To measure the mean cerebral circulation time (CCT) in patients with symptomatic vasospasm stemming from subarachnoid hemorrhage and to determine any change after papaverine treatment. METHODS We studied 27 patients who received intraarterial papaverine from November 1992 to August 1995 to determine the CCT in 59 carotid territories. CCT was measured from the first image in which contrast was seen above the supraclinoid internal carotid artery to the peak filling of parietal cortical veins. Angiograms at the time of presentation were examined in 19 of the 27 patients. A control population of 19 patients (30 carotid territories) was also studied. RESULTS The mean CCT on presentation was 6.8 seconds +/- 1.1. The prepapaverine mean CCT was 6.1 seconds +/- 1.2. The immediate postpapaverine mean CCT was 3.8 seconds +/- 0.8. CCT decreased in 58 of 59 territories treated with papaverine; the mean change was -35.7%. In eight of these patients, CCT rose on the following day to 6.1 seconds +/- 1.1. In the control group, mean CCT was 5.9 seconds +/- 0.8. The mean CCT in patients with subarachnoid hemorrhage was slightly prolonged on presentation relative to that in control subjects. CONCLUSION Intraarterial papaverine produces a consistent decrease in CCT in patients with vasospasm.