Gdc Coiling And Intraventricular rtPa After Aneurysm

Intraventricular hemorrhage and clotting is considered a predictor of poor outcome after SAH, leading to poor neurologic grade and acute hydrocephalus. Two patients who had ruptured cerebral aneurysms and extensive casting of their ventricular systems with blood were treated with GDC coiling and intraventricular recombinant tissue plasminogen activator (rtPA), after which clot resolution was demonstrated radiographically, and both had marked improvement in neurologic status (116). According to one study, patients treated with rtPA had a shorter length of stay, decreased mortality, and better Glasgow Outcome Scale and modified Rankin Scale scores at discharge, and they needed fewer interventions for hydrocephaly (117). However, some studies have reported hemorrhagic complications, such as epidural hematomas and hemorrhage extension, with intraventricular fibrinolysis (118). In addition, excessive amounts of intraventricular rtPA can cause additional brain tissue injury by way of intraventricular leukocytosis and edema of periventricular tissues and choroid plexus (119). One group hypothesized that these complications would be minimized with a lower dose of rtPA and found that intraventricular fibrinolysis was effective at a lower dose than previously reported in the literature (120 ).

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