Evidence map›Paper›PMID 40705141›Full record

ArticleActa neurochirurgica2025

Imaging efficacy and safety of low dose intraventricular tissue plasminogen activator in aneurysmal subarachnoid hemorrhage: case series.

Collin Liu, William W Wroe, Hussein A Zeineddine, Bryden Dawes, Michael Giordano, Aaron McCabe, Ching-Jen Chen, Devin W McBride, Aaron M Gusdon, Huimahn A Choi and 1 more

Abstract read
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In one paragraph

Article in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Collin LiuDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
William W WroeDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA. William.W.Wroe@uth.tmc.edu.
Hussein A ZeineddineDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
Bryden DawesDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
Michael GiordanoMinnetronix Medical, St. Paul, MN, USA.
Aaron McCabeMinnetronix Medical, St. Paul, MN, USA.
Ching-Jen ChenDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
Devin W McBrideDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
Aaron M GusdonDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
Huimahn A ChoiDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA.
Spiros L BlackburnDepartment of Neurosurgery, The University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 2800, Houston, TX, 77030, USA. spiros.blackburn@uth.tmc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionFree hemoglobin's release into CSF from blood breakdown is a primary instigator of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Early clearance of subarachnoid blood with intrathecal (IT) fibrinolytics has shown potential to decrease incidence of DCI. However, the dosage of fibrinolytic needed is not known. We investigated the ability of low dose tissue plasminogen activator (tPA) to rapidly remove subarachnoid clot. MATERIAL AND

methodsWe performed a single center retrospective review of aSAH patients who received IT tPA. Dosing consistent with the CLEAR III trial for IVH was utilized-tPA (1 mg) administered every 8 h via an external ventricular drain (EVD) for up to three doses. CT imaging was obtained before initiation and after the final dose. Subarachnoid clot was quantified using the Hijdra score on initial and follow-up scans. The IT tPA group was compared to a large retrospective cohort without IT tPA.

resultsEight aSAH patients received IT tPA treatment for the purpose of increasing blood removal after aSAH. CT imaging indicated that the Hijdra Score had a 70-100% reduction in all patients in the first 4 days with a mean 81.6% reduction compared to 41.3% reduction in a prior natural history cohort, p = 0.001. No ventriculitis or hemorrhagic complications were observed the treatment group. Clinical DCI and radiographic vasospasm was observed in two of the patients.

conclusionLow dose IT tPA delivered through an EVD after aSAH is sufficient to rapidly increase CSF blood clearance on CT imaging.

Indexed as

Brain IschemiaFibrinolytic AgentsSubarachnoid HemorrhageTissue Plasminogen ActivatorAdultAgedFemaleHumansInjections, IntraventricularMaleMiddle AgedRetrospective StudiesTomography, X-Ray ComputedTreatment OutcomeFibrinolytic AgentsTissue Plasminogen ActivatorAneurysmal subarachnoid hemorrhageCerebrospinal FluidFibrinolysisVasospasm

Identifiers

PMID40705141
PMCPMC12289764

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.