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...
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Published in | Neurosurgical review Vol. 47; no. 1; p. 40 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
10.01.2024
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Abstract | 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. |
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AbstractList | 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. 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. 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. |
ArticleNumber | 40 |
Author | Spader, Heather Carlson, Andrew P. Andrada, Jason E. Sarangarm, Preeyaporn Carrera, Diego A. Cole, Chad D. Nelson, Danika E. Mabray, Marc C. Torbey, Michel T. |
AuthorAffiliation | 4 Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM, USA 1 Department of Neurology, University of New Mexico, Albuquerque, NM, USA 2 Department of Radiology, University of New Mexico, Albuquerque, NM, USA 3 School of Medicine, University of New Mexico, Albuquerque, NM, USA 5 Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA |
AuthorAffiliation_xml | – name: 3 School of Medicine, University of New Mexico, Albuquerque, NM, USA – name: 4 Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM, USA – name: 5 Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA – name: 1 Department of Neurology, University of New Mexico, Albuquerque, NM, USA – name: 2 Department of Radiology, University of New Mexico, Albuquerque, NM, USA |
Author_xml | – sequence: 1 givenname: Diego A. surname: Carrera fullname: Carrera, Diego A. organization: Department of Neurology, University of New Mexico – sequence: 2 givenname: Marc C. surname: Mabray fullname: Mabray, Marc C. organization: Department of Radiology, University of New Mexico – sequence: 3 givenname: Michel T. surname: Torbey fullname: Torbey, Michel T. organization: Department of Neurology, University of New Mexico – sequence: 4 givenname: Jason E. surname: Andrada fullname: Andrada, Jason E. organization: Department of Neurology, University of New Mexico – sequence: 5 givenname: Danika E. surname: Nelson fullname: Nelson, Danika E. organization: School of Medicine, University of New Mexico – sequence: 6 givenname: Preeyaporn surname: Sarangarm fullname: Sarangarm, Preeyaporn organization: Department of Pharmacy, University of New Mexico Hospital – sequence: 7 givenname: Heather surname: Spader fullname: Spader, Heather organization: Department of Neurosurgery, University of New Mexico School of Medicine – sequence: 8 givenname: Chad D. surname: Cole fullname: Cole, Chad D. organization: Department of Neurosurgery, University of New Mexico School of Medicine – sequence: 9 givenname: Andrew P. surname: Carlson fullname: Carlson, Andrew P. email: AndrewCarlson@salud.unm.edu organization: Department of Neurology, University of New Mexico, Department of Neurosurgery, University of New Mexico School of Medicine |
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Keywords | Intraventricular hemorrhage Continuous irrigation Intracerebral hemorrhage Intraventricular thrombolysis |
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Snippet | Intraventricular hemorrhage (IVH) is a complication of a spontaneous intracerebral hemorrhage. Standard treatment is with external ventricular drain (EVD).... |
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SubjectTerms | Brain Case-Control Studies Cerebral Hemorrhage - drug therapy Cerebral Hemorrhage - surgery Fibrinolytic Agents - therapeutic use Humans Medicine Medicine & Public Health Neurosurgery |
Title | Continuous irrigation with thrombolytics for intraventricular hemorrhage: case–control study |
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