Abstract 3443: No Exacerbation of Perihematomal Edema or Ventricular Volume with Intraventricular Tissue Plasminogen Activator in Patients with Spontaneous Intraventricular Hemorrhage
Introduction: In severe spontaneous intraventricular hemorrhage (IVH), intraventricular (IVR) administration of tissue plasminogen activator (tPA) results in more rapid clearing of blood from the ventricles than with external ventricular drainage (EVD) alone. However, experimental studies suggest tPA may be neurotoxic in compromised brain tissue and may exacerbate perihematomal edema.
Methods: We used computerized volumetrics to assess change in intracerebral hemorrhage (ICH), IVH, ventricular and peri-ICH edema (PHE) volumes at 2-5 (T1) and 5-9 (T2) days following diagnostic CT scans (T0) of 20 patients (10 tPA treated; 10 controls) with IVH requiring EVD. Control patients from a hospital database treated with EVD alone were matched by IVH and ICH volume to tPA-treated patients. Treated patients came from two multicenter trials involving 100 patients with IVH, and spontaneous ICH volume <30cc and received a median of 4 doses (range 1-8) of tPA.
Results: There were no significant differences between matched pairs in terms of age, admission Glasgow Coma Score, Graeb IVH score, PHE volume, total ventricular volume, or ICH volume. Median IVH volume was larger in the tPA-treated group (26.2 cc iqr10.2 vs. 23.1 cc iqr9.2; P=0.02). IVR tPA resulted in more rapid clearance of IVH as determined by T2-T0 decrease in Graeb score and median IVH volume (tPA: -18.7 (10.8) cc; control:-7.6 (3.2) cc; P=0.005). Ratios of PHE to ICH volume were non-significantly higher in control vs. tPA treated patients at T1 and T2 [control:tPA = 0.82:0.77 (T1);P=0.44 and 0.64:0.56 (T2);P=0.48]. Total ventricular volume was significantly larger in the control group at T2 (median: 41.7 (36.9) cc vs. tPA: 24.5 (11.9) cc; P=0.02) and cumulative median cerebrospinal fluid drainage was non-significantly higher (control: 1079 (463) cc vs. tPA: 639 (428) cc; P=0.08). Ventriculitis was more frequent in the control group (4 vs. 2 episodes; P=0.08) as was shunt dependence (4 vs. 0 cases; P=0.04).
Conclusions: For case matched large IVH with small ICH volume, IVR tPA enhances lysis of intraventricular blood clots, accelerates resolution of post-hemorrhagic hydrocephalus and has no significant impact on perihematomal edema.
- © 2012 by American Heart Association, Inc.