| Intraventricular tissue plasminogen activator for the prevention of vasospasm and hydrocephalus after aneurysmal subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 20559098 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: The sequelae of aneurysmal subarachnoid hemorrhage (SAH) include vasospasm and hydrocephalus. OBJECTIVE: To assess whether intraventricular tissue plasminogen activator (tPA) results in less vasospasm, fewer angioplasties, or fewer cerebrospinal fluid shunting procedures. METHODS: 41 patients (tPA group, Hunt and Hess 3, 4, 5) from 2007 to 2008 received intraventricular tPA and lumbar drainage for a minimum of 5 days (range 5-7 days) and were compared to a matched group of 35 patients from 2006 to 2007 (Control, HH 3, 4, 5). Statistical comparison was done by t test analysis or Fisher exact tests and data are expressed as average+/-standard error of the mean. RESULTS: There were no significant differences in demographic data, although the tPA group had a trend toward more surgical patients. The tPA group of patients had a significantly higher modified Fisher grade than controls (P<.001) and had a significantly better Hunt and Hess grade than controls (P<.03). The angioplasty rate was significantly lower among the tPA patients (15.0%+/-5.6) than controls (40.0%+/-8.5, P=.019). The number of days spent in severe vasospasm normalized over the 14-day monitoring period by transcranial Doppler was significantly lower in the tPA group (0.09+/-0.02) than controls (0.17+/-0.03). The shunt rate was significantly lower among tPA patients (17.5%+/-6.0) than controls (42.8%+/-8.6). There were 2 clinically silent tract hemorrhages in the tPA group (4.8%). CONCLUSION: Intraventricular tPA is a safe and effective treatment for reducing both angioplasty and shunting rates in patients with SAH H&H Grades 3 to 5. A randomized trial is indicated. |
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Authors:
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Rohan Ramakrishna; Laligam N Sekhar; Dinesh Ramanathan; Nancy Temkin; Danial Hallam; Basavaraj V Ghodke; Louis J Kim |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 67 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-06-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: 110-7; discussion 117 Citation Subset: IM |
Affiliation:
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Department of Neurological Surgery, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington 98104, USA. |
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Comment In:
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Neurosurgery. 2011 Jan;68(1):E288-9; author reply E289
[PMID:
21150745
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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