Continuous irrigation with thrombolytics for intraventricular hemorrhage: case–control study
Intraventricular hemorrhage (IVH) is a complication of a spontaneous intracerebral hemorrhage. Standard treatment is with external ventricular drain (EVD). Intraventricular thrombolysis may improve mortality but does not improve functional outcomes. We present our initial experience with a novel irr...
Saved in:
Published in | Neurosurgical review Vol. 47; no. 1; p. 40 |
---|---|
Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
10.01.2024
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Intraventricular hemorrhage (IVH) is a complication of a spontaneous intracerebral hemorrhage. Standard treatment is with external ventricular drain (EVD). Intraventricular thrombolysis may improve mortality but does not improve functional outcomes. We present our initial experience with a novel irrigating EVD (IRRAflow) that automates continuous irrigation with thrombolysis.
Single-center case–control study including patients with IVH treated with EVD compared to IRRAflow. We compared standard demographics, treatment, and outcome parameters between groups. We developed a brain phantom injected with a human clot and assessed clot clearance using EVD/IRRAflow approaches with CT imaging.
Twenty-one patients were treated with standard EVD and 9 patients with IRRAflow. Demographics were similar between groups. Thirty-three percent of patients with EVD also had at least one dose of t-PA and 89% of patients with IRRAflow received irrigation with t-PA (
p
= 0.01). Mean drain days were 8.8 for EVD versus 4.1 for IRRAflow (
p
= 0.02). Days-to-clearance of ventricular outflow was 5.8 for EVD versus 2.5 for IRRAflow (
p
= 0.02). Overall clearance was not different. Thirty-seven percent of EVD patients achieved good outcome (mRS
≥
3) at 90 days versus 86% of IRRAflow patients (
p
= 0.03). Assessing only t-PA, reduction in mean days-to-clearance (
p
= 0.0004) and ICU days (
p
= 0.04) was observed. In the benchtop model, the clot treated with IRRAflow and t-PA showed a significant reduction of volume compared to control.
Irrigation with IRRAflow and t-PA is feasible and safe for patients with IVH. Improving clot clearance with IRRAflow may result in improved clinical outcomes and should be incorporated into randomized trials. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1437-2320 0344-5607 1437-2320 |
DOI: | 10.1007/s10143-023-02270-3 |