Intravascular Infusion of Lidocaine: A Novel Way to Relieve Sudden Internal Carotid Artery Occlusion in Embolization of Intracranial Aneurysms^[*]

 

 Buy Article Permissions and Reprints

Abstract

Background Sudden internal carotid artery (ICA) occlusive vasospasm is a serious complication of intracranial aneurysm embolization. Conventional spasmolysis with papaverine yields a generally poor outcome. We believe that arterial infusion of lidocaine may offer a better outcome.

Materials and Methods We retrospectively reviewed the outcome of patients treated with either papaverine or lidocaine infusion for vasospasm during embolization.

Results 14 patients undergoing intracranial aneurysm embolization had a ICA occlusive vasospasm. Among the 8 patients who received conventional treatment with papaverine the vasospasm improved partially in 5. In 3 cases, treatment was ineffective. 6 of the patients died within 3 days. 2 patients developed hemispheric infarction and underwent a decompressive craniectomy and subtotal resection of the infarct; 1 of these 2 patients died after 4 months and the other was severely disabled. In the 6 patients treated with lidocaine, spasmolysis and subsequent aneurysm treatment was succesful in 5. In 1 patient who had preoperative stenosis of the carotid artery proximal to the aneurysm spasmolysis failed.

Conclusions ICA occlusive spasm is an extremely serious and often lethal complication in embolization of intracranial aneurysms. Conventional treatment with papaverine has a poor outcome, whereas arterial infusion of lidocaine may achieve better results.

^* This article was originally published online in Central Eruopean Neurosurgery on Janauary 12, 2011 (DOI: 10.1055/s-0031-1279754)

• References

• 1 Dorsch NW. Therapeutic approaches to vasospasm in subarachnoid hemorrhage. Curr Opin Crit Care 2002; 8: 128-133
  CrossrefPubMedGoogle Scholar
• 2 Hirashima Y, Endo S, Kato R , et al. Prevention of cerebrovasospasm following subarachnoid hemorrhage in rabbits by the platelet-activating factor antagonist, E5880. J Neurosurg 1996; 84: 826-830
  CrossrefPubMedGoogle Scholar
• 3 Hoh BL, Topcuoglu MA, Singhal AB , et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery 2004; 55: 779-786 ; discussion 786–789
  CrossrefPubMedGoogle Scholar
• 4 Komotar RJ, Zacharia BE, Valhora R , et al. Advances in vasospasm treatment and prevention. J Neurol Sci 2007; 261: 134-142
  CrossrefPubMedGoogle Scholar
• 5 Mocco J, Zacharia BE, Komotar RJ , et al. A review of current and future medical therapies for cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Neurosurg Focus 2006; 21 (3) E9
  PubMedGoogle Scholar
• 6 Biller J, Godersky JC, Adams HP. Management of aneurysmal subarachnoid hemorrhage. Stroke 1988; 19: 1300-1305
  CrossrefPubMedGoogle Scholar
• 7 Kosty T. Cerebral vasospasm after subarachnoid hemorrhage: an update. Crit Care Nurs Q 2005; 28: 122-134
  PubMedGoogle Scholar
• 8 Treggiari-Venzi MM, Suter PM, Romand JA. Review of medical prevention of vasospasm after aneurysmal subarachnoid hemorrhage: a problem of neurointensive care. Neurosurgery 2001; 48: 249-261 ; discussion 261–262
  CrossrefPubMedGoogle Scholar
• 9 Petzold GC, Einhaupl KM, Dirnagl U , et al. Ischemia triggered by spreading neuronal activation is induced by endothelin-1 and hemoglobin in the subarachnoid space. Ann Neurol 2003; 54: 591-598
  CrossrefPubMedGoogle Scholar
• 10 Takahashi S, Oida K, Fujiwara R , et al. Effect of cilostazol, a cyclic AMP phosphodiesterase inhibitor, on the proliferation of rat aortic smooth muscle cells in culture. J Cardiovasc Pharmacol 1992; 20: 900-906
  CrossrefPubMedGoogle Scholar
• 11 Jung CS, Iuliano BA, Harvey-White J , et al. Association between cerebrospinal fluid levels of asymmetric dimethyl-L-arginine, an endogenous inhibitor of endothelial nitric oxide synthase, and cerebral vasospasm in a primate model of subarachnoid hemorrhage. J Neurosurg 2004; 101: 836-842
  CrossrefPubMedGoogle Scholar
• 12 Pluta RM, Dejam A, Grimes G , et al. Nitrite infusions to prevent delayed cerebral vasospasm in a primate model of subarachnoid hemorrhage. JAMA 2005; 293: 1477-1484
  CrossrefPubMedGoogle Scholar
• 13 Pluta RM, Thompson BG, Dawson TM , et al. Loss of nitric oxide synthase immunoreactivity in cerebral vasospasm. J Neurosurg 1996; 84: 648-654
  CrossrefPubMedGoogle Scholar
• 14 Suzuki Y, Osuka K, Noda A , et al. Nitric oxide metabolites in the cisternal cerebral spinal fluid of patients with subarachnoid hemorrhage. Neurosurgery 1997; 41: 807-811 ; discussion 811–812
  CrossrefPubMedGoogle Scholar
• 15 Feng L, Fitzsimmons BF, Young WL , et al. Intraarterially administered verapamil as adjunct therapy for cerebral vasospasm: safety and 2-year experience. AJNR Am J Neuroradiol 2002; 23: 1284-1290
  PubMedGoogle Scholar
• 16 Ilia R, Cafri C, Jafari J , et al. Prolonged catheter-induced coronary artery spasm mimicking fixed stenosis. Cathet Cardiovasc Diagn 1997; 41: 170-173
  CrossrefPubMedGoogle Scholar
• 17 Biondi A, Ricciardi GK, Puybasset L , et al. Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. AJNR Am J Neuroradiol 2004; 25: 1067-1076
  PubMedGoogle Scholar
• 18 Song JK, Elliott JP, Eskridge JM. Neuroradiologic diagnosis and treatment of vasospasm. Neuroimaging Clin N Am 1997; 7: 819-835
  PubMedGoogle Scholar
• 19 Murray GD. Surgical bleeding and calcium antagonists. British aneurysm nimodipine trial reported improved clinical outcome with nimodipine. BMJ 1995; 311: 388-389
  PubMedGoogle Scholar
• 20 Pickard JD, Murray GD, Illingworth R , et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989; 298: 636-642
  CrossrefPubMedGoogle Scholar
• 21 Rosenwasser RH, Armonda RA, Thomas JE , et al. Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options. Neurosurgery 1999; 44: 975-979 ; discussion 979–980
  CrossrefPubMedGoogle Scholar
• 22 Zubkov YN, Nikiforov BM, Shustin VA. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien) 1984; 70: 65-79
  CrossrefPubMedGoogle Scholar
• 23 Fujii Y, Takahashi A, Yoshimoto T. Effect of balloon angioplasty on high grade symptomatic vasospasm after subarachnoid hemorrhage. Neurosurg Rev 1995; 18: 7-13
  CrossrefPubMedGoogle Scholar
• 24 Kobayashi H, Ide H, Aradachi H , et al. Histological studies of intracranial vessels in primates following transluminal angioplasty for vasospasm. J Neurosurg 1993; 78: 481-486
  CrossrefPubMedGoogle Scholar
• 25 Megyesi JF, Vollrath B, Cook DA , et al. Long-term effects of in vivo angioplasty in normal and vasospastic canine carotid arteries: pharmacological and morphological analyses. J Neurosurg 1999; 91: 100-108
  CrossrefPubMedGoogle Scholar
• 26 Tremont-Lukats IW, Challapalli V, McNicol ED , et al. Systemic administration of local anesthetics to relieve neuropathic pain: a systematic review and meta-analysis. Anesth Analg 2005; 101: 1738-1749
  PubMedGoogle Scholar
• 27 Layton AM, Cotterill JA. Notalgia paraesthetica–report of three cases and their treatment. Clin Exp Dermatol 1991; 16: 197-198
  CrossrefPubMedGoogle Scholar