Intrahematomal catheter placement with connection to the ventricular system allows more effective thrombolysis of combined intracerebral and intraventricular hematomas

Autor: Vesna Malinova, Dorothee Mielke, Anna Schlegel, Veit Rohde, Bogdan Iliev
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Ventricular system
Conservative Treatment
Infections
Catheterization
Cerebral Ventricles
030218 nuclear medicine & medical imaging
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Cerebrospinal fluid
Hematoma
Fibrinolytic Agents
Internal medicine
medicine
Humans
Thrombolytic Therapy
cardiovascular diseases
Aged
Retrospective Studies
Aged
80 and over
business.industry
General Medicine
Thrombolysis
Middle Aged
medicine.disease
nervous system diseases
Hydrocephalus
Catheter
Treatment Outcome
Intraventricular hemorrhage
medicine.anatomical_structure
Ventricle
Tissue Plasminogen Activator
Cardiology
Female
Surgery
Neurology (clinical)
business
Intracranial Hemorrhages
030217 neurology & neurosurgery
Zdroj: Neurosurgical Review. 43:1531-1537
ISSN: 1437-2320
0344-5607
DOI: 10.1007/s10143-019-01170-9
Popis: Intracerebral hematomas (ICH) with intraventricular hemorrhage (IVH) are associated with high morbidity. Catheter-based thrombolysis with recombinant tissue plasminogen activator (rtPA) allows a faster hematoma resolution compared to conservative treatment. However, simultaneous thrombolysis of ICH and IVH is not achievable because the ependyma hinders ICH-lysis if rtPA is given into the ventricles and inversely. We evaluated if the thrombolysis efficacy is enhanced by placing an intrahematomal catheter reaching the ventricle. Patients with ICH plus IVH treated with catheter-based thrombolysis were retrospectively analyzed. Group 1 included patients with an intrahematomal catheter reaching the ventricles and group 2 patients with a catheter placed exclusively in the ICH. The relative hematoma volume reduction (RVR) of ICH and IVH within 3 days was calculated. Furthermore, the patients' outcome, the hydrocephalus incidence, and the infection rate were evaluated. A total of 74 patients were analyzed, of whom 49% had a catheter reaching the ventricle. The mean ICH-RVR (68% vs. 58%, p = 0.0001) and IVH-RVR were significantly higher in group 1 compared to group 2. In group 1, infections occurred more often compared to group 2 (31% vs. 6%, p = 0.005). There was no difference in outcome and in hydrocephalus incidence between both groups. The catheter reaching the ventricles allows simultaneous and more effective thrombolysis of ICH and IVH. We assume that the fibrinolytic property of cerebrospinal fluid itself and a washout effect contribute to these findings. In patients with ICH plus IVH, catheter positioning through the hematoma into the ventricle, and subsequent fibrinolytic therapy should be considered.
Databáze: OpenAIRE
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