The aim of our study was to determine the effect of intrathecal lysis therapy on the volume of ICH. Intraparenchymal hematoma expansion following intrathecal lysis therapy of IVH could explain these disappointing results, since neurological impairment due to ICH is directly associated with the clot size. Studies provide evidence for a reduction in all-cause mortality but shows no improvement in functional outcome. However, a clinical benefit from reduction in IVH due to irrigation of fibrinolytic substances through an external ventricular drainage (EVD) has been difficult to demonstrate in humans. Due to its high impact on mortality and morbidity, diverse treatment strategies for IVH have been evaluated in the past. Intraventricular hemorrhage (IVH)-an extension of the ICH due to irruption of the bleeding into the ventricular system-is reported in more than 50% of patients with ICH and its volume is among the main predictors for poor outcome. Spontaneous intracerebral hemorrhage (ICH) is a life-threatening event leading to high mortality rates and permanent disability in surviving patients. Furthermore, intrathecal rtPA application had no adverse effect on ICH volume. Intrathecal lysis therapy leads to a significant reduction in the intraparenchymal hematoma volume with faster clot resolution compared to the spontaneous hematoma resorption. There were no adverse events in Group A related to rtPA instillation. Comparison of first and last CT scan in Group A confirmed an overall median percentage reduction of 91.7% ( n = 36, p < 0.01) of ICH volumes and hematoma resolution in Group A was significantly more effective compared to non-rtPA group, Group B (percentage reduction = 68%) independent of initial hematoma volume in the regression analysis ( p = 0.07, mean 11.1, 95%CI 7.7–14.5). Twenty-six patients received a second treatment with rtPA (ICH volume reduction 4.5 to 3.3 ml, p < 0.01) and of this cohort further 16 patients underwent a third treatment (ICH volume reduction 3.0 ml to 1.5 ml, p < 0.01). Median initial volume of ICH for treatment Group A was 6.5 ml and was reduced to 5.0 ml after first instillation of rtPA ( p < 0.01). The Wilcoxon signed-rank test was performed for statistical analysis in not normally distributed variables.
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Serial CT scans were evaluated separately for changes in ICH volumes for both cohorts using OsiriX DICOM viewer.
During the same period, 41 patients with ICH without relevant IVH were treated without intrathecal lysis therapy at our neurocritical care unit (Group B). Initial volumes were determined in the first available computed tomography (CT) scan, final volumes in the last CT scan before discharge. Methodsīetween 01/2013 and 01/2019, 36 patients with IVH caused by hemorrhage of basal ganglia, thalamus or brain stem were treated with rtPA via an EVD (Group A). In this series, we analyzed volumetric changes of ICH in patients with and without intrathecal lysis therapy.
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Instillation of recombinant tissue plasminogen activator (rtPA) via an external ventricular drainage (EVD) has been shown to effectively decrease IVH volumes while the impact of rtPA instillation on ICH volumes remains unclear. Intraventricular hemorrhage (IVH) is often caused by irruption of intracerebral hemorrhage (ICH) of basal ganglia or thalamus into the ventricular system.