Intraventricular Fibrinolysis has No Effects on Shunt Dependency and Functional Outcome in Endovascular-Treated Aneurysm
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ORIGINAL ARTICLE
Intraventricular Fibrinolysis has No Effects on Shunt Dependency and Functional Outcome in Endovascular-Treated Aneurysmal SAH Stefan T. Gerner • Joji B. Kuramatsu • Henning Abel • Stephan P. Kloska Hannes Lu¨cking • Ilker Y. Eyu¨poglu • Arnd Doerfler • Stefan Schwab • Hagen B. Huttner
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Ó Springer Science+Business Media New York 2014
hemorrhage was increased [Graeb Score: IVF = 7(6–8) vs. non-IVF = 3(1–4); p B 0.001]. Consecutive matched controlled sub-analysis revealed no significant therapeutic effect of IVF with respect to shunt dependency rate and functional outcome. Multivariate analysis revealed Graeb score [OR = 1.34(1.02–1.76); p = 0.035] and sepsis [OR = 11.23(2.28–55.27); p = 0.003] as independent predictors for shunt dependency, whereas IVF did not exert significant effects (p = 0.820). Conclusions In endovascular-treated SAH patients IVF neither reduced permanent shunt dependency nor influenced functional outcome. Despite established effects on intraventricular clot resolution IVF appears less powerful in SAH as compared to ICH. Given the reported positive effects of lumbar drainage (LD) in SAH, a prospective analysis of a combined treatment approach of IVF and subsequent lumbar drain seems warranted aiming to reduce permanent shunting and improve functional outcome.
Abstract Background Intraventricular fibrinolysis (IVF) in subarachnoid hemorrhage (SAH) is an emerging strategy aiming to hasten clot lysis, treat hydrocephalus, and reduce permanent shunt rates. Because of clinical heterogeneity of investigated patient effects of IVF on permanent shunt incidence and functional outcome are widely debated. The present study is the first to investigate solely endovasculartreated SAH patients. Methods Overall, 88 consecutive patients with aneurysmal SAH requiring external ventricular drain placement and endovascular aneurysm closure were included. Functional outcome and shunt dependency were assessed 90 days after event. A matched controlled sub-analysis was carried out to investigate the effects of IVF treatment (n = 14; matching criteria: age, neuro-status and imaging). Multivariate modeling was performed to identify independent predictors for permanent shunt dependency. Results In IVF-patients neurological status was significantly poorer [Hunt&Hess: IVF = 4(3–5) vs. nonIVF = 3(1–5); p = 0.035] and the extent of ventricular
Keywords SAH Intraventricular fibrinolysis Permanent shunting Outcome
Stefan T. Gerner and Joji B. Kuramatsu have contributed equally.
Introduction
S. T. Gerner J. B. Kuramatsu H. Abel S. Schwab H. B. Huttner (&) Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany e-mail: [email protected] S. P. Kloska H. Lu¨cking A. Doerfler Department of Neuroradiology, University of ErlangenNuremberg, Schwabachanlage 6, 91054 Erlangen, Germany I. Y. Eyu¨poglu Department of Neurosurgery, University of ErlangenNuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
Post-hemorrhagic hydrocephalus (PHH
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