使用IRRAflow自冲洗导管对与原发性高血压性出血相关的成人脑室内出血进行引流、冲洗和纤维蛋白溶解疗法（DRIFT）：三例报告及既往历史对照

Drainage, Irrigation, and Fibrinolytic Therapy (DRIFT) for Adult Intraventricular Hemorrhage Associated with Primary Hypertensive Hemorrhages Using IRRAflow Self-Irrigating Catheter: A Report of Three Cases and Prior Historical Controls.

作者信息

Field Nicholas C, Custozzo Amanda J, Harland Tessa A, Sweeney Jared F, Adamo Matthew A, Dalfino John C, Paul Alexandra R

机构信息

Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.

出版信息

World Neurosurg. 2023 Sep;177:137-142. doi: 10.1016/j.wneu.2023.06.069. Epub 2023 Jun 23.

DOI:10.1016/j.wneu.2023.06.069

PMID:37356487

Abstract

BACKGROUND

Spontaneous primary intracerebral hemorrhage (ICH) accounts for 10%-15% of strokes and is accompanied by ventricular involvement in 10%-30% of cases. Intraventricular hemorrhage (IVH) is a poor prognostic factor and the current treatment paradigm of external ventricular drainage requires frequent flushing and replacement. Given the documented high rate of failure standard EVD catheters, we sought to determine if the use of the IRRAflow system with the addition of alteplase would be beneficial in this patient population for the treatment of IVH associated with primary hypertensive ganglionic hemorrhages.

METHODS

Three patients with ganglionic hemorrhages and IVH underwent treatment with the IRRAflow system at our institution from December 2022 to January 2023. A retrospective review was then performed of patients with primary hypertensive ganglionic hemorrhages and EVD placement at our institution from January 2021 to present day.

RESULTS

Three patients underwent treatment with the IRRAflow system and continuous lavage of Tissue Plasminogen Activator (tPA). The IVH was efficiently cleared in all cases and the drains were removed within 8 days in all cases. No patients required replacement of the drain and there were no hemorrhagic complications noted. In our retrospective review, 28 patients were identified who underwent placement of a standard EVD for the treatment of primary hypertensive ganglionic hemorrhages. When patients who had early withdrawal of care were excluded, the average length of EVD treatment was 11.3 days and the EVD replacement rate was 24%.

CONCLUSIONS

We demonstrate here that the use of the IRRAflow system for the treatment of primary hypertensive hemorrhages with IVH results in rapid clearance of the IVH without safety concerns. Compared to historical controls there was a decrease in EVD duration, EVD replacement and, ICU LOS.

摘要

背景

自发性原发性脑出血（ICH）占中风的10%-15%，10%-30%的病例伴有脑室受累。脑室内出血（IVH）是一个预后不良的因素，目前的外部脑室引流治疗模式需要频繁冲洗和更换。鉴于标准脑室外引流（EVD）导管的失败率较高，我们试图确定使用IRRAflow系统并加用阿替普酶是否对该患者群体治疗与原发性高血压性神经节出血相关的IVH有益。

方法

2022年12月至2023年1月，3例患有神经节出血和IVH的患者在我们机构接受了IRRAflow系统治疗。然后对2021年1月至今在我们机构接受原发性高血压性神经节出血和EVD置入的患者进行回顾性研究。

结果

3例患者接受了IRRAflow系统治疗并持续冲洗组织型纤溶酶原激活剂（tPA）。所有病例的IVH均有效清除，所有病例的引流管均在8天内拔除。没有患者需要更换引流管，也没有观察到出血并发症。在我们的回顾性研究中，确定了28例接受标准EVD置入以治疗原发性高血压性神经节出血的患者。排除早期放弃治疗的患者后，EVD治疗的平均时长为11.3天，EVD更换率为24%。