Document Detail


Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator.
MedLine Citation:
PMID:  8433145     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The authors have evaluated the efficacy of postoperative intrathecal injections of tissue-type plasminogen activator (tPA) in preventing cerebral vasospasm in patients with a diffuse thick subarachnoid hemorrhage (SAH). The present study examined 105 patients who underwent direct surgery within 48 hours of SAH and whose computerized tomography (CT) findings were classified as Fisher CT Group 3. Patients showing diffuse thick subarachnoid blood clots on CT with greater than 75 Hounsfield units (HU) were included in the tPA therapy group and those with below 75 HU comprised the control group. The surgical method was the same in both groups, and both groups had cisternal drainage instituted. On the day following the operation, the tPA group was given an intrathecal injection of tPA (2 mg), and this was continued for several days until all of the cisterns exhibited low density on CT scans. Follow-up angiography showed that 26 cases (87%) in the tPA group had no vasospasm, three (10%) had moderate vasospasm, and one (3%) had severe vasospasm. All four patients showing spasm on angiography were asymptomatic, and there were no cases of delayed ischemic neurological deficits (DIND). In contrast, there were 11 cases (15%) with DIND in the control group. In the tPA group, there was one case of SAH caused by drainage catheter removal, one with a small epidural hematoma, and one with subgaleal fluid accumulation; all of these were treated conservatively with favorable results. Overall, there were no infectious complications related to cisternal drainage and intrathecal injection of tPA. These results indicate that multiple intrathecal injections of small doses of tPA are effective and safe in preventing vasospasm. On the basis of this experience, the authors conclude that injection of 2 mg of tPA daily for 5 days (a total of 10 mg) is effective in preventing the development of vasospasm.
Authors:
K Mizoi; T Yoshimoto; A Takahashi; S Fujiwara; K Koshu; T Sugawara
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  78     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1993 Mar 
Date Detail:
Created Date:  1993-03-17     Completed Date:  1993-03-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  430-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Humans
Injections, Spinal
Ischemic Attack, Transient / complications,  drug therapy*,  etiology,  prevention & control*,  radiography
Male
Middle Aged
Prospective Studies
Subarachnoid Hemorrhage / complications,  drug therapy*
Tissue Plasminogen Activator / administration & dosage*
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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