Early cisternal fibrinolysis is more effective than rescue spasmolysis for the prevention of delayed infarction after subarachnoid haemorrhage  

作　　者：Roland Roelz Christian Scheiwe Jürgen Grauvogel Istvan Csok Volker Arnd Coenen Jürgen Beck Peter C Reinacher 

机构地区：[1]Department of Neurosurgery,Medical Center-University of Freiburg,Freiburg,Germany [2]Department of Stereotactic and Functional Neurosurgery,Medical Center-University of Freiburg,Faculty of Medicine,Freiburg,Germany [3]Fraunhofer Institute for Laser Technology(ILT),Aachen,Germany

出　　处：《Stroke & Vascular Neurology》2022年第2期108-113,共6页卒中与血管神经病学（英文）

基　　金：funded by the Berta-Ottenstein-Programme for Advanced Clinician Scientists,Faculty of Medicine,University of Freiburg.

摘　　要：Background To compare the efficacy of two different concepts of cisternal therapy—PREVENTIVE fibrinolysis plus on-demand spasmolysis versus RESCUE spasmolysis—for the prevention of cerebral vasospasm(CVS)and delayed cerebral infarction(DCI)in patients with aneurysmal subarachnoid haemorrhage(aSAH).Methods Retrospective analysis of 84 aSAH patients selected for cisternal therapy for DCI prevention.66 high-risk patients received PREVENTIVE cisternal therapy to enhance blood clearance.Either stereotactic catheter ventriculocisternostomy(STX-VCS)or intraoperative placement of a cisterno-ventriculostomy catheter(CVC),followed by fibrinolytic cisternal lavage using urokinase was performed.In case of vasospasm,nimodipine was applied intrathecally.22 low-risk patients who developed CVS against expectations were selected for STX-VCS as RESCUE intervention for cisternal spasmolysis with nimodipine.Rates of DCI and mean flow velocities of daily transcranial Doppler(TCD)ultrasonographies were evaluated.Results Despite a higher prespecified DCI risk,patients selected for PREVENTIVE intervention primarily aiming at blood clearance had a lower DCI rate compared with patients selected for intrathecal spasmolysis as a RESCUE therapy(11.3%vs 18.2%).After intrathecal treatment onset,CVS(TCD>160 cm/s)occurred in 45%of patients with PREVENTIVE and 77%of patients with RESCUE therapy(p=0.013).A stronger response of CVS to intrathecal nimodipine was observed in patients with PREVENTIVE intervention as the mean CVS duration after start of intrathecal nimodipine was 3.2 days compared with 5.8 days in patients with RESCUE therapy(p=0.026).Conclusions PREVENTIVE cisternal therapy directed at blood clearance is more effective for the prevention of CVS and delayed infarction compared with cisternal RESCUE spasmolysis.

关 键 词：PREVENTION spasmolysis INFARCTION 

分 类 号：R743[医药卫生—神经病学与精神病学]