improvement in 60-80% of patients within minutes of the procedure, with evidence of improved rCBF on TCD and SPECT, correlating with reversal of ischemic deficits. Normal angiographic calibre is achieved in 66% of cases, which persists without recurrent spasm. Most reports recommend intervention as soon as it is apparent that a patient is progressing or failing to improve despite maximal medical treatment and before the development of infarction, as ultimate outcome is dependent on the clinical grade of the patient at the time of angioplasty.
Direct intra-arterial papaverine, using super-selective catheters, results in clinical improvement in 50-80% and angiographic improvement in 65-95% of patients with vasospasm . This again correlates with rCBF changes on SPECT, although SPECT shows a greater and more sustained improvement in rCBF with angioplasty than papaverine. Spasm is commonly recurrent following intra-arterial papaverine, but is often successfully reversed with a second treatment.
A combined approach, using both angio-plasty and intra-arterial papaverine, has been suggested. Papaverine can be used to dilate up vessels temporarily, to allow the passage of the angioplasty balloon; alternatively, angioplasty can be used to treat proximal vasospasm, whilst papaverine deals with the smaller, more distal vessels that are inaccessible to angioplasty.
Was this article helpful?
The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.