The effect of intraventricular thrombolysis in combination with low-frequency head motion after severe subarachnoid hemorrhage: interim analysis of safety, clot clearance rate and delayed cerebral ischemia.
OBJECTIVE
The current clinical prospective randomized phase II study was initiated in order to analyze the effect of enhanced washout by discontinuous intraventricular thrombolysis in combination with low-frequency head-motion therapy on side effects, clot clearance rate, cerebral vasospasm and clinical outcome after severe subarachnoid hemorrhage (SAH).


METHODS
Data from 40 adult patients with aneurysmal SAH were included in this interim analysis. Patients randomized to the study group achieved additional intraventricular application of rt-PA (Actilyse(®)) bolus 5 mg every 12 h and lateral rotational therapy (RotoRest(®)). Clot clearance rate was evaluated based on computed tomography (CT). Delayed cerebral ischemia (DCI) and early clinical outcome of patients were determined.


RESULTS
No severe side effects due to the combined therapy were documented. The clot clearance rate was significantly higher in the study group than in the control group regarding the cranial and basal CT slices (p = 0.003 cranial slices and p = 0.037 basal slices). Delayed ischemic neurological deficits (DIND) were increased in the control group (p = 0.016).


CONCLUSIONS
The present study demonstrates that a combination of intraventricular thrombolysis and lateral rotational therapy is not associated with a higher complication rate. Furthermore, the therapy leads to a significant acceleration of the clot clearance rate.
Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. eicker.s@mac.com
Sven O
SO
Eicker
Kerim
K
Beseoglu
Nima
N
Etminan
Jason
J
Perrin
Arzu
A
Taskin
Hans-Jakob
HJ
Steiger
Daniel
D
Hänggi
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D002545:Brain Ischemia / Q000209:etiology* / Q000628:therapy; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000628:therapy