Intrathecal fibrinolysis using recombinant tissue plasminogen activator (rTPA) for prevention of cerebral vasospasm and delayed ischaemic deficits after aneurysmal subarachnoid haemorrhage. Experimental and clinical data.

Cerebral vasospasm and delayed ischaemic neurological deficits (DIND) remain the leading cause of death and major disability after aneurysmal subarachnoid haemorrhage (SAH). Experimental and clinico-radiological studies have clearly demonstrated the relationship between the volume of blood accumulated in the basal cisterns after aneurysm rupture and SAH, and the incidence and severity of vasospasm and DIND. Recently intrathecal thrombolysis using recombinant tissue plasminogen activator (rTPA) has been introduced as an innovative pharmacological method for the removal of subarachnoid blood accumulations, in order to prevent the development of cerebral vasospasm. In this survey a number of experimental and clinical studies which have been performed recently by the neurovascular research group of the author on the possible use of rTPA during SAH will be presented and discussed in the light of other experimental investigations as well as other recently performed pilot studies on the use of rTPA.