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Continuous irrigation with thrombolytics for intraventricular hemorrhage: Case-Control Study

Friday, May 3, 2024

Presenting Author(s)

Andrew P. Carlson, MD

Associate Professor of Neurosurgery with Tenure
Department of Neurosurgery,University of New Mexico Hospital, Albuquerque,New Mexico, USA
Albuquerque, NM, US

Co-Author(s)

DC

Diego Carrera, MD

Resident
Department of Neurosurgery, University of New Mexico
JA

Jason Andrada, MD

Resident
Department of Neurology, University of New Mexico, United States
CC

Chad Cole, MD

Attending physician
Department of Neurosurgery, University of New Mexico, United States
MM

Marc Mabray, MD

Chief of Neuroradiology
Department of Radiology, University of New Mexico, United States
DN

Danika Nelson, BS

MD/PhD Candidate
UNM School of Medicine, United States
PS

Preeyaporn Sarangarm, PharmD

Pharmacist
Department of Pharmacy, University of New Mexico, United States
HS

Heather S. Spader, MD

Attending physician
Department of Neurosurgery, University of New Mexico, United States
MT

Michel Torbey, MD

Department Chair
Department of Neurology, University of New Mexico, United States

Introduction: 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 that automates continuous irrigation with thrombolysis.

Methods: Single-center case-control study including patients with IVH treated with EVD compared to irrigating EVD. We compared standard demographics, treatment, and outcome parameters between groups.

Results: 21 patients were treated with standard EVD and 9 patients with irrigating EVD. Demographics were similar between groups. 33% of patients with EVD also had at least one dose of t-PA and 89% of patients with irrigating EVD received irrigation with t-PA (p=0.01). Mean drain days were 8.8 for EVD versus 4.1 for irrigating EVD (p=0.02). Days-to-clearance of ventricular outflow was 5.8 for EVD versus 2.5 for irrigating EVD (p=0.02). Overall clearance was not different. 37% of EVD patients achieved good outcome (mRS≥3) at 90 days versus 86% of irrigating EVD 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.

Conclusion : Irrigation with irrigating EVD and t-PA is feasible and safe for patients with IVH. Improving clot clearance with irrigating EVD may result in improved clinical outcomes and should be incorporated into randomized trials.