Effect on cerebral vasospasm of coil embolization followed by microcatheter intrathecal urokinase infusion into the cisterna magna: A prospective randomized study

• Published in: Stroke (1970) 2003-11, Vol.34 (11), p.2549-2554
• Main Authors: HAMADA, Jun-Ichiro, KAI, Yutaka, MORIOKA, Motohiro, YANO, Shigetoshi, MIZUNO, Takamasa, HIRANO, Teruyuki, KAZEKAWA, Kiyoshi, USHIO, Yukitaka
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm, Ruptured - complications; Aneurysm, Ruptured - diagnostic imaging; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain - blood supply; Brain - diagnostic imaging; Catheterization; Cerebral Angiography; Cisterna Magna; Combined Modality Therapy; Diseases of the nervous system; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - instrumentation; Female; Glasgow Coma Scale; Humans; Infusions, Parenteral; Injections, Spinal; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnostic imaging; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Plasminogen Activators - administration & dosage; Plasminogen Activators - adverse effects; Plasminogen Activators - therapeutic use; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Urokinase-Type Plasminogen Activator - administration & dosage; Urokinase-Type Plasminogen Activator - adverse effects; Urokinase-Type Plasminogen Activator - therapeutic use; Vasospasm, Intracranial - complications; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - therapy
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000094731.63690.FF

Vasospasm remains the leading cause of death and permanent neurological disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The objective of our prospective randomized trial of coil embolization followed by intrathecal urokinase infusion into the cisterna magna (ITUKI therapy) was to test its effectiveness in preventing or alleviating the severity of ischemic neurological deficits caused by vasospasm. We enrolled 110 patients with ruptured intracranial aneurysms eligible for coil embolization and randomly assigned them to embolization with (n=57) or without (n=53) ITUKI therapy performed within 24 hours of aneurysmal SAH. The incidence of symptomatic vasospasms and the clinical outcomes, based on the Glasgow Outcome Scale, 6 months after SAH onset were assessed. There were no side effects or adverse reactions attributable to ITUKI therapy. Symptomatic vasospasm occurred in 5 patients (8.8%) with and 16 (30.2%) without ITUKI therapy; the difference was significant (P=0.012). Although the mortality rate did not differ between the groups, patients with ITUKI therapy had significantly better outcomes than those without (P=0.036). Our results demonstrate that ITUKI therapy significantly reduced the occurrence of symptomatic vasospasm. Although it did not completely prevent vasospasms, ITUKI therapy resulted in a lower rate of permanent neurological deficits.