title: Intraventricular fibrinolysis has no effects on shunt dependency and functional outcome in endovascular-treated aneurysmal SAH.
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.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Gerner
authors.forename: Joji B
authors.initials: JB
authors.lastname: Kuramatsu
authors.forename: Henning
authors.initials: H
authors.lastname: Abel
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Kloska
authors.forename: Hannes
authors.initials: H
authors.lastname: Lücking
authors.forename: Ilker Y
authors.initials: IY
authors.lastname: Eyüpoglu
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
mesh_terms: D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles; D002557:Cerebrospinal Fluid Shunts / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004322:Drainage; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000628:therapy*; D007276:Injections, Intraventricular; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator