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

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.

Keywords

intracranial aneurysm - interventional therapy - carotid artery spasm - lidocaine

^* 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
• 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
• 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
• 4 Komotar RJ, Zacharia BE, Valhora R , et al. Advances in vasospasm treatment and prevention. J Neurol Sci 2007; 261: 134-142
• 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
• 6 Biller J, Godersky JC, Adams HP. Management of aneurysmal subarachnoid hemorrhage. Stroke 1988; 19: 1300-1305
• 7 Kosty T. Cerebral vasospasm after subarachnoid hemorrhage: an update. Crit Care Nurs Q 2005; 28: 122-134
• 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
• 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
• 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
• 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
• 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
• 13 Pluta RM, Thompson BG, Dawson TM , et al. Loss of nitric oxide synthase immunoreactivity in cerebral vasospasm. J Neurosurg 1996; 84: 648-654
• 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
• 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
• 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
• 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
• 18 Song JK, Elliott JP, Eskridge JM. Neuroradiologic diagnosis and treatment of vasospasm. Neuroimaging Clin N Am 1997; 7: 819-835
• 19 Murray GD. Surgical bleeding and calcium antagonists. British aneurysm nimodipine trial reported improved clinical outcome with nimodipine. BMJ 1995; 311: 388-389
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 27 Layton AM, Cotterill JA. Notalgia paraesthetica–report of three cases and their treatment. Clin Exp Dermatol 1991; 16: 197-198