Effect on cerebral vasospasm of coil embolization followed by microcatheter intrathecal urokinase infusion into the cisterna magna: a prospective randomized study.
OBJECTIVE
Vasospasm remains the leading cause of death and permanent neurological disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The objective of our prospective randomized trial of coil embolization followed by intrathecal urokinase infusion into the cisterna magna (ITUKI therapy) was to test its effectiveness in preventing or alleviating the severity of ischemic neurological deficits caused by vasospasm.


METHODS
We enrolled 110 patients with ruptured intracranial aneurysms eligible for coil embolization and randomly assigned them to embolization with (n=57) or without (n=53) ITUKI therapy performed within 24 hours of aneurysmal SAH. The incidence of symptomatic vasospasms and the clinical outcomes, based on the Glasgow Outcome Scale, 6 months after SAH onset were assessed.


RESULTS
There were no side effects or adverse reactions attributable to ITUKI therapy. Symptomatic vasospasm occurred in 5 patients (8.8%) with and 16 (30.2%) without ITUKI therapy; the difference was significant (P=0.012). Although the mortality rate did not differ between the groups, patients with ITUKI therapy had significantly better outcomes than those without (P=0.036).


CONCLUSIONS
Our results demonstrate that ITUKI therapy significantly reduced the occurrence of symptomatic vasospasm. Although it did not completely prevent vasospasms, ITUKI therapy resulted in a lower rate of permanent neurological deficits.
Hamada
Jun-ichiro
J
Department of Neurosurgery, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-856, Japan. jhamada@kaiju.medic.kumamoto-u.ac.jp
Kai
Yutaka
Y
Morioka
Motohiro
M
Yano
Shigetoshi
S
Mizuno
Takamasa
T
Hirano
Teruyuki
T
Kazekawa
Kiyoshi
K
Ushio
Yukitaka
Y
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002404:Catheterization; D002533:Cerebral Angiography; D002946:Cisterna Magna; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007263:Infusions, Parenteral; D007278:Injections, Spinal; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator