Intraventricular hemorrhage after aneurysmal subarachnoid hemorrhage: Pilot study of treatment with intraventricular tissue plasminogen activator

Panayiotis N. Varelas, Kim L. Rickert, Joseph Cusick, Lotfi Hacein-Bey, Grant Sinson, Michel Torbey, Marianna Spanaki, Thomas A. Gennarelli

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVE: Intraventricular (IVen) hemorrhage is considered a predictor of poor outcome after subarachnoid hemorrhage (SAH). This prospective study examines the feasibility and outcome of administration of IVen tissue plasminogen activator (tPA) after aneurysmal SAH. METHODS: Ten patients with SAH who received IVen tPA after the aneurysm had been secured were compared with 10 age-, sex-, and Glasgow Coma Scale score-matched control patients. The primary end point was third and fourth ventricle clot resolution. IVen blood was quantified by use of the Graeb and Le Roux scales on admission and at an additional time (equal or longer for the control group) after the injection was terminated. RESULTS: Six men and four women with a mean age of 52 years in each group were evaluated. On average, 3.5 mg tPA was injected 68 ± 51 hours after admission without ensuing complications. Although the treated group had significantly more IVen blood on admission than control subjects (mean Le Roux scale ± standard deviation, 11 ± 3 versus 7.6 ± 4.2, P= 0.055, and mean Graeb scale ± standard deviation, 8.5 ± 2.3 in tPA versus 5.3 ± 3, P < 0.02), it also had a significant decrease in the amount of IVen blood (mean Le Roux and Graeb scale decrease ± standard deviation, 6.7 ± 3.3 and 4.8 ± 2 in tPA patients versus 0.9 ± 3.2 and 0.5 ± 2.6 in control subjects, P = 0.002). The tPA group had a non-statistically significantly shorter length of stay, decreased mortality, and better Glasgow Outcome Scale and modified Rankin Scale scores at discharge. Treated survivors showed a decreased need for shunt placement (2 [22%] of 9 patients versus 5 [83%] of 6 control subjects, P = 0.04). CONCLUSION: This pilot study shows that IVen tPA administration is feasible without complications after SAH and may be associated with better outcomes. These results warrant a randomized clinical trial.

Original languageEnglish (US)
Pages (from-to)205-212
Number of pages8
JournalNeurosurgery
Volume56
Issue number2
DOIs
StatePublished - Feb 2005

Fingerprint

Tissue Plasminogen Activator
Subarachnoid Hemorrhage
Hemorrhage
Therapeutics
Glasgow Outcome Scale
Fourth Ventricle
Glasgow Coma Scale
Third Ventricle
Aneurysm
Survivors
Length of Stay
Randomized Controlled Trials
Prospective Studies
Control Groups
Injections
Mortality

Keywords

  • Intraventricular
  • Subarachnoid hemorrhage
  • Thrombolysis
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Intraventricular hemorrhage after aneurysmal subarachnoid hemorrhage : Pilot study of treatment with intraventricular tissue plasminogen activator. / Varelas, Panayiotis N.; Rickert, Kim L.; Cusick, Joseph; Hacein-Bey, Lotfi; Sinson, Grant; Torbey, Michel; Spanaki, Marianna; Gennarelli, Thomas A.

In: Neurosurgery, Vol. 56, No. 2, 02.2005, p. 205-212.

Research output: Contribution to journalArticle

Varelas, Panayiotis N. ; Rickert, Kim L. ; Cusick, Joseph ; Hacein-Bey, Lotfi ; Sinson, Grant ; Torbey, Michel ; Spanaki, Marianna ; Gennarelli, Thomas A. / Intraventricular hemorrhage after aneurysmal subarachnoid hemorrhage : Pilot study of treatment with intraventricular tissue plasminogen activator. In: Neurosurgery. 2005 ; Vol. 56, No. 2. pp. 205-212.
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AU - Varelas, Panayiotis N.

AU - Rickert, Kim L.

AU - Cusick, Joseph

AU - Hacein-Bey, Lotfi

AU - Sinson, Grant

AU - Torbey, Michel

AU - Spanaki, Marianna

AU - Gennarelli, Thomas A.

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N2 - OBJECTIVE: Intraventricular (IVen) hemorrhage is considered a predictor of poor outcome after subarachnoid hemorrhage (SAH). This prospective study examines the feasibility and outcome of administration of IVen tissue plasminogen activator (tPA) after aneurysmal SAH. METHODS: Ten patients with SAH who received IVen tPA after the aneurysm had been secured were compared with 10 age-, sex-, and Glasgow Coma Scale score-matched control patients. The primary end point was third and fourth ventricle clot resolution. IVen blood was quantified by use of the Graeb and Le Roux scales on admission and at an additional time (equal or longer for the control group) after the injection was terminated. RESULTS: Six men and four women with a mean age of 52 years in each group were evaluated. On average, 3.5 mg tPA was injected 68 ± 51 hours after admission without ensuing complications. Although the treated group had significantly more IVen blood on admission than control subjects (mean Le Roux scale ± standard deviation, 11 ± 3 versus 7.6 ± 4.2, P= 0.055, and mean Graeb scale ± standard deviation, 8.5 ± 2.3 in tPA versus 5.3 ± 3, P < 0.02), it also had a significant decrease in the amount of IVen blood (mean Le Roux and Graeb scale decrease ± standard deviation, 6.7 ± 3.3 and 4.8 ± 2 in tPA patients versus 0.9 ± 3.2 and 0.5 ± 2.6 in control subjects, P = 0.002). The tPA group had a non-statistically significantly shorter length of stay, decreased mortality, and better Glasgow Outcome Scale and modified Rankin Scale scores at discharge. Treated survivors showed a decreased need for shunt placement (2 [22%] of 9 patients versus 5 [83%] of 6 control subjects, P = 0.04). CONCLUSION: This pilot study shows that IVen tPA administration is feasible without complications after SAH and may be associated with better outcomes. These results warrant a randomized clinical trial.

AB - OBJECTIVE: Intraventricular (IVen) hemorrhage is considered a predictor of poor outcome after subarachnoid hemorrhage (SAH). This prospective study examines the feasibility and outcome of administration of IVen tissue plasminogen activator (tPA) after aneurysmal SAH. METHODS: Ten patients with SAH who received IVen tPA after the aneurysm had been secured were compared with 10 age-, sex-, and Glasgow Coma Scale score-matched control patients. The primary end point was third and fourth ventricle clot resolution. IVen blood was quantified by use of the Graeb and Le Roux scales on admission and at an additional time (equal or longer for the control group) after the injection was terminated. RESULTS: Six men and four women with a mean age of 52 years in each group were evaluated. On average, 3.5 mg tPA was injected 68 ± 51 hours after admission without ensuing complications. Although the treated group had significantly more IVen blood on admission than control subjects (mean Le Roux scale ± standard deviation, 11 ± 3 versus 7.6 ± 4.2, P= 0.055, and mean Graeb scale ± standard deviation, 8.5 ± 2.3 in tPA versus 5.3 ± 3, P < 0.02), it also had a significant decrease in the amount of IVen blood (mean Le Roux and Graeb scale decrease ± standard deviation, 6.7 ± 3.3 and 4.8 ± 2 in tPA patients versus 0.9 ± 3.2 and 0.5 ± 2.6 in control subjects, P = 0.002). The tPA group had a non-statistically significantly shorter length of stay, decreased mortality, and better Glasgow Outcome Scale and modified Rankin Scale scores at discharge. Treated survivors showed a decreased need for shunt placement (2 [22%] of 9 patients versus 5 [83%] of 6 control subjects, P = 0.04). CONCLUSION: This pilot study shows that IVen tPA administration is feasible without complications after SAH and may be associated with better outcomes. These results warrant a randomized clinical trial.

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