Innovations in aneurysmal subarachnoid hemorrhage: intracisternal t-PA for the prevention of vasospasm

J Neurosci Nurs. 1996 Apr;28(2):107-13. doi: 10.1097/01376517-199604000-00008.

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) affects approximately 30,000 people each year in North America. At least 30% of these patients will develop vasospasm as a result of the initial hemorrhage, and two thirds of these develop permanent disabilities or die. Blood deposited into the basal cisterns from the ruptured aneurysm can form thick clots around the major cerebral vessels. The by-products of the hemolyzed clots are believed to be responsible for the subsequent development of vasospasm. Hypervolemic, hypertensive, hemodilution therapy (HHHT) and nimodipine may improve outcome in some cases but there is no therapy known to prevent vasospasm in all patients. One potential therapeutic agent under investigation is tissue plasminogen activator (t-PA), a fibrinolytic enzyme. Instilled into the basal cisterns at time of aneurysm clipping, t-PA dissolves the clot so spasmogenic substances may be removed, thus preventing or reducing the severity of vasospasm.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Aneurysm, Ruptured / complications*
  • Cisterna Magna*
  • Female
  • Humans
  • Instillation, Drug
  • Intracranial Aneurysm / complications*
  • Ischemic Attack, Transient / etiology*
  • Ischemic Attack, Transient / prevention & control
  • Male
  • Plasminogen Activators / therapeutic use*
  • Radiography
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / drug therapy*
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome

Substances

  • Plasminogen Activators
  • Tissue Plasminogen Activator