Influence of intraoperative using of recombinant tissue plasminogen activator on the development of cerebral angiospasm after subarachnoid haemorrhage in patients with ruptured intracranial aneurysms.

For a few years conducted experimental studies and clinical trials set one's hopes on the role of the fibrynolytic treatment using recombinant tissue plasminogen activator (rt-PA) in preventing cerebral vasospasm. In our study the target population was 45 patients with ruptured saccular aneurysms causing severe SAH. In the group of 24 patients treatment consisted of a single intraoperative injection of 10 mg of rt-PA into the opened basal subarachnoid cisterns following aneurysm clipping. The patients underwent surgery with aneurysm clipping within 72 hours from subarachnoid haemorrhage in all patients. Control group of 21 patients underwent early operation after SAH and rt-PA was not given. All patients had significant basal cistern blood accumulation seen on CT scans preoperatively according to Fisher's grade III. Patients in our study were classified in clinical grade I and II according to classification of Hunt/Hess. Transcranial Doppler Daily examinations in postoperative course were performed in all patients. The postoperative results were evaluated according to Glasgow Outcome Scale. Postoperatively patients were evaluated by daily transcranial Doppler and serial CT scans. TCD demonstrated reduction in the development of vasospasm to a greater degree in the rt-PA treated group. Serial CT examinations demonstrated radical blood clot removal in all rt-PA treated patients. The postoperative results according to the Glasgow Outcome Scale in the rt-PA treated group were as follow: 22 patients were grades I and II, 2 patients were grade III. In the control group 13 patients were grades I and II, 6 patients were grade III, and 2 patients died. In the rt-PA treated group only one patient presented delayed ischemic deficit.