INTRAVENTRICULAR RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR FOR LYSIS OF INTRAVENTRICULAR HEMORRHAGE

A prospective series of 20 patients with moderate to severe intraventr icular haemorrhage (IVH) was studied for the effect of intraventricula r administration of recombinant tissue plasminogen activator (rt-PA) o n reduction of haematoma volume and prognosis. On the day of haemorrha ge ventriculostomy was performed and 2 to 5 mg of rt-PA were infected via the external ventricular drainage, followed by drainage closure fo r two hours. In 14 patients rt-PA treatment was repeated. Computed tom ography showed complete clot lysis or substantial reduction of intrave ntricular haematoma volume in 19 patients within 96 hours; the clearan ce of the third and fourth ventricle preceded the clearance of the lat eral ventricles. Decrease of ventricular enlargement was seen in all b ut one patient with initial ventricular dilatation. Increase of haemat oma volume and ventricular size was found in one patient. Outcome was minor or no neurological deficit in nine patients, disabling neurologi cal deficit in six patients, and vegetative status in four patients. O ne patient did not survive the IVH. Intraventricular treatment with rt -PA seems effective in rapid lysis of intraventricular haematoma and n ormalisation of impaired CSF circulation. This treatment may contribut e to an improvement in prognosis of moderate to severe IVH.