Effects Of Intraventricular Recombinant Tissue Type Plasminogen Activator On DCI And Prognosis After Aneurysmal Subarachnoid Hemorrhage

Objective:To investigate the effect of intraventricular recombinant tissue type plasminogen activator(rtPA)on the incidence of delayed cerebral ischemia and prognosis after aneurysmal subarachnoid hemorrhage(a SAH)by comparing the treatment of intraventricular rtPA combined with external ventricular drainage(EVD)inserted and the treatment of external ventricular drainage.Methods:The author analyzed the clinical data of 70 patients with a SAH who had an operation and had EVD inserted and given rtPA through EVD or had EVD inserted alone in the department of neurosurgery,Affiliated Zhang Jiajie Hospital of Hunan Normal University from January 2018 to December 2020.A propensity scorematched analysis(PSM)was done using a multivariable logistic regression model based on: gender,age,GCS score on admission,Hunt-Hess grade,Fisher grade,the modified Greab score on adissioion and the grading amount of blood after a SAH on admission.70 patients were derived using 1:1 greedy nearest neighbor matching within PS score of 0.02.This strategy resulted in 22 matched pairs in each Group.The incidence of delayed cerebral ischemia(DCI),the condition of SAH and ventricle blood clearance,the m RS grade and barthel index after 3 months,the incidence of cerebral infarction and hydrocephalus will be compared between two groups.Results:There were 2 cases of DCI in rtPA group,and there were 8 cases of DCI in EVD group.The DCI rate of rtPA group and EVD group were 9.1% and 36.4%.The rate of DCI in rtPA group was significantly lower than that in EVD group,and ⅹ~2=4.659,P=0.031.The Grading Amount of Blood After SAH 1.5(0-4.25)in the rtPA group was significantly lower than that in the EVD group 3(1.75-7),P=0.036.The clearance rate of SAH in rtPA group was 0.82(0.6-1),which was significantly higher than that in external ventricular drainage group 0.62(0.43-0.8).The Modified Graeb score 1(0-2)in the rtPA group was lower than that in the EVD group 2(0.75-4.5)on the third day after surgery,and the clearance rate of IVH blood in rtPA group 0.5(0-0.75)was higher than that in the EVD group 0(0-0.5),but the difference was not statistically signifificant.There was no significant difference between the two groups in the modified Rankin score and Barthel index after 3 months,death at 30 days,hydrocephalus and cerebral infarction.However,the modified Graeb score on the first and third days after surgery were positively correlated with the modified Rankin scores at 3 month(r= 0.398,P= 0.007;r=0.334,P=0.026)and it was negatively correlated with Barthel Index at 3 months(r=-0.332,P=0.028;r=-0.326,P=0.031).There was no significant difference in the rate of intracranial infection and the rate of new intracranial bleeding between the rtPA group and the EVD group.Conclusion:Intraventricular rtPA with external ventricular drainage can reduce the occurrence of DCI and accelerate blood clearance of SAH,and intraventricular rtPA did not increase the risk of intracranial hemorrhage and infection.However,there was no effect on improving prognosis possibly.Fewer IVH blood is associated with better outcome,so it is a safe and feasible treatment for preventing and treating DCI possibly.