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Intraventricular Fibrinolysis has No Effects on Shunt Dependency and Functional Outcome in Endovascular-Treated Aneurysmal SAH

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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 endovascular-treated 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. non-IVF = 3(1–5); p = 0.035] and the extent of ventricular hemorrhage was increased [Graeb Score: IVF = 7(6–8) vs. non-IVF = 3(1–4); p ≤ 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 sOeems warranted aiming to reduce permanent shunting and improve functional outcome.

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Acknowledgments

We would like to thank Petra Burkardt and Kerstin Wagner for helping with clinical data acquisition and Inken Martin for valuable discussions.

Conflict of interest

Stefan Gerner, Joji Kuramatsu, Henning Abel, Stephan Kloska, Hannes Lücking, Ilker Eyüpoglu, Arnd Dörfler, Stefan Schwab and Hagen Huttner declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Stefan T. Gerner, Joji B. Kuramatsu, Henning Abel, Stefan Schwab & Hagen B. Huttner

  2. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Stephan P. Kloska, Hannes Lücking & Arnd Doerfler

  3. Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Ilker Y. Eyüpoglu

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  1. Stefan T. Gerner
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Correspondence to Hagen B. Huttner.

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Stefan T. Gerner and Joji B. Kuramatsu have contributed equally.

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Gerner, S.T., Kuramatsu, J.B., Abel, H. et al. Intraventricular Fibrinolysis has No Effects on Shunt Dependency and Functional Outcome in Endovascular-Treated Aneurysmal SAH. Neurocrit Care 21, 435–443 (2014). https://doi.org/10.1007/s12028-014-9961-3

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