Neurosurgical Review

, Volume 36, Issue 4, pp 523–531 | Cite as

Intraventricular fibrinolysis for severe aneurysmal intraventricular hemorrhage: a randomized controlled trial and meta-analysis

  • Stephane Litrico
  • Fabien Almairac
  • Thomas Gaberel
  • Rohan Ramakrishna
  • Denys Fontaine
  • Jacques Sedat
  • Michel Lonjon
  • Philippe Paquis
Original Article

Abstract

The aim of this study was to assess the safety and efficacy of intraventricular fibrinolysis (IVF) for aneurysmal subarachnoid hemorrhage (aSAH) with severe intraventricular hemorrhage (IVH). In this randomized controlled trial, between 2005 and 2009, patients with aSAH and severe IVH were randomly assigned into two groups: one treated with external ventricular drainage (EVD) combined with intraventricular recombinant tissue plasminogen activator (rt-PA) and the second with EVD alone. The primary end-point was mortality rate within the first 30 days. We performed meta-analysis including all published articles that compared IVF + EVD to EVD alone in patients with aSAH IVH. Eleven patients were included in the rt-PA group, eight in the control group. At 30 days, mortality rate was lower in the rt-PA group (45.5 vs. 62.5 %), but results were not statistically significant (p = 0.65). Clearance of third and fourth ventricles was obtained previously in the rt-PA group (4.25 days) compared to the control group (10.67 days) (p = 0.001). There was no statistically significant difference concerning the occurrence of complications. The meta-analysis showed a better survival rate with IVF without raised statistical significance (odds ratio = 0.32 [95 % confidence interval, 0.10–1.03]). This study shows that IVF is as safe as EVD alone for aSAH with severe IVH. It accelerates blood clot resolution in the ventricular system. Mortality rate could be improved by IVF but without significant results. Because of the severity and rarity of this pathology, a multicenter study is required.

Clinical Trial Registration Information: www.clinicaltrials.gov (NCT00823485)

Keywords

Intraventricular hemorrhage Subarachnoid hemorrhage Tissue plasminogen activator Fibrinolytic agents Randomized controlled trial Meta-analysis 

Notes

Acknowledgments

We wish to express our gratitude to Dr. Laligam N. Sekhar from the University of Washington Medical Center, Seattle, USA, for his prompt response to our data request. This trial was financed by the Institutional Review Board of the Nice Hospital University, France.

Conflict of interest

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Stephane Litrico
    • 1
  • Fabien Almairac
    • 1
    • 6
  • Thomas Gaberel
    • 2
    • 3
  • Rohan Ramakrishna
    • 5
  • Denys Fontaine
    • 1
  • Jacques Sedat
    • 4
  • Michel Lonjon
    • 1
  • Philippe Paquis
    • 1
  1. 1.Department of NeurosurgeryUniversity Hospital of Nice, Hôpital PasteurNiceFrance
  2. 2.Department of NeurosurgeryUniversity Hospital of CaenCaenFrance
  3. 3.INSERM U919, Sérine Protease and Pathophysiology of the Neurovascular Unit, SP2U, UMR CNRS 6232, Centre d’Imagerie et de Neurosciences Appliquées aux Pathologies, GIP CyceronUniversity Caen Lower NormandyCaenFrance
  4. 4.Department of NeuroradiologyUniversity Hospital of Nice, Hôpital St RochNiceFrance
  5. 5.Department of Neurological SurgeryUniversity of WashingtonSeattleUSA
  6. 6.Department of NeurosurgeryCHU de Nice, Hôpital PasteurNiceFrance

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