Primary intraventricular hemorrhage outcomes in the CLEAR III trial

Nelson, Sarah E.; Mould, W. Andrew; Gandhi, Dheeraj; Thompson, Richard E.; Salter, Sarah H.; Dlugash, Rachel; Awad, Issam A.; Hanley, Daniel F.; Ziai, Wendy

doi:10.1177/1747493020908146

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…On the other hand death rates in 30 -50 ml group were 48% and < 30 ml group were only 11.12% (Table -IV); with a chi-square test result was 100.7416 and p-value < 0.00001, that was statistically significant and coincide with the study shown that increased volume of hemorrhage increased mortality, Broderick J et al shows that a model of 30 day mortality that used the Glasgow coma scale and hemorrhage volume in patients with intracerebral hemorrhage correctly predicted outcome with a sensitivity and specificity of 97% 29 . 51.50% of patients (n=103) presented with ventricular extension of which 61.17% (n=63) of patients died within 1 month (Table -V), with p-value < 0.00001 that was statistically significant and co-relates with several studies 36,37 .…”

Section: Resultsmentioning

confidence: 63%

Intraventricular Hemorrhage Extension is a Strong Predictor of Mortality in Hemorrhagic Stroke

Mamun¹,

Sheikh

Rahman

et al. 2023

Med. Today

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Introduction: Spontaneous intracerebral hemorrhage (sICH) accounts for 10–15% of all strokes and is characterized by a 30–50% 3-month mortality rate. Intraventricular hemorrhage (IVH) extension can be seen in up to 54% of spontaneous intracerebral hemorrhage and is an independent predictor of worse outcome and neurological deterioration. Objective: To predict outcome and prognosis in spontaneous intracerebral hemorrhage patient in relation with intraventricular hemorrhage extension. Materials and Methods: Hospital based prospective study carried out in two hundred hemorrhagic stroke patients. The severity of intraventricular hemorrhage extension was calculated using the Graeb scale and volume of hemorrhage was measured by ABC/2 formula using CT scan. Results: Mean age of patients of hemorrhagic stroke was 61.64 ± 12.76 years. 66% of patients were male. Mortality rate of hemorrhagic stroke after the age of 60 years was 47.92% in 1st month. 79.80% of patients were died with GCS score less than 8. In our study 96.08% of patient died with >50 ml Hemorrhage group, on the other hand mortality rate was 48% in 30-50ml hemorrhage group and 11.12% in <30ml hemorrhage group. Mortality rate was 61.17% in hemorrhagic stroke with ventricular extension group on the other hand mortality was 21.65% in hemorrhagic stroke without ventricular extension. Those patients with GRAEB score >5 their mortality rate was 75.00% on the other hand mortality was 49.10% in GRAEB score 1-4. Conclusion: Intraventricular hemorrhage extension increased mortality in spontaneous intracerebral hemorrhage. Increased IVH extension severity, defined by a GRAEB score _5, is an independent predictor of poor outcome of Spontaneous intracerebral hemorrhage alone with age, GCS and hemorrhage volume. Medicine Today 2023 Vol.35(1): 34-39

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Section: Resultsmentioning

confidence: 63%

Intraventricular Hemorrhage Extension is a Strong Predictor of Mortality in Hemorrhagic Stroke

Mamun¹,

Sheikh

Rahman

et al. 2023

Med. Today

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“…Larger hematoma volume and ventricle intrusion can lead to life-threatening cerebral herniation, acute obstructive hydrocephalus, and delayed vasospasm, ultimately resulting in respiratory and circulatory failure. [ 30 31 32 ] Therefore, protecting cardiac function is crucial in the context of surgically treated hypertensive ICH to enhance patient survival.…”

Section: Discussionmentioning

confidence: 99%

Impaired Kidney Function Portended a Bleak Prognosis for Surgically Treated Hypertensive Intracerebral Hemorrhage Patients

Wang,

Qin

et al. 2023

Annals of Indian Academy of Neurology

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Purpose: Spontaneous intracerebral hemorrhage (ICH) cases caused by hypertension often have poor prognoses. The use of dehydrant agents, such as mannitol, is common to reduce intracranial pressure and alleviate cerebral edema, but they may also pose a risk of worsening kidney function. This study aimed to investigate the impact of impaired kidney function on the outcomes of surgically treated hypertensive ICH patients. Methods: We conducted a retrospective analysis of a consecutive cohort of patients who underwent surgical intervention due to hypertension-related ICH at our institute between December 1, 2017, and January 31, 2022. Demographic, clinical, radiological, and prognostic data were collected. Patients were categorized into two groups based on 90-day mortality: group A [overall survival (OS) ≤3 months] and group B (OS >3 months). Survival analysis was performed to identify factors associated with poor outcomes. Results: Among the 232 eligible patients, group A exhibited significantly impaired kidney function, as indicated by mean estimated glomerular filtration rate (eGFR) at admission, postoperative, 3-day postoperative, and 7-day postoperative time points (91.9, 82.5, 73.5, 75.2 ml/min/1.73 m²). In contrast, group B did not show significant changes in kidney function (mean eGFR for the corresponding time points: 108.1, 106.5, 111.5, 109.6 ml/min/1.73 m²). The 3-day postoperative eGFR showed the strongest predictive ability for assessing prognosis [areas under the curve (AUC): 0.617, 0.675, 0.737, 0.730]. Univariate and multivariate analyses identified low Glasgow Coma Scale (GCS) score (3–8), ventricle intrusion of hematomas, cardiac failure, larger hematoma volume, infection, and lower 3-day postoperative eGFR as adverse factors for survival. Conclusions: Preserving kidney function is crucial for achieving favorable outcomes in hypertensive ICH cases. Impaired 3-day postoperative eGFR emerged as an independent risk factor for overall survival. Patients with cardiac failure, infection, and larger hematoma volume should receive careful management to improve outcomes.

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“…A systematic review has found that EVD is still a standard treatment in IVH with hydrocephalus, and intraventricular injection of thrombolytics commonly used for rapid hemorrhagic removal in IVH 31 . The clinical trial, CLEAR III, found that intraventricular injection of recombinant tissue plasminogen activator (rt-PA) was safe with no related symptomatic hemorrhage in IVH 32 .…”

Section: Discussionmentioning

confidence: 99%

The accuracy and safety of intraoperative ultrasound-guided external ventricular drainage in intraventricular hemorrhage

Zhang

Shen

et al. 2023

Sci Rep

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Severe IVH often results in a poor outcome. Currently, EVD is a standard treatment for IVH, but there is little research to show whether using ultrasound to guide the catheter placement improves outcome. Patients with severe IVH who had iUS-guided EVD (the iUS-guided group) were enrolled retrospectively and compared with a group who had EVD performed without ultrasound guidance (the control group) from January 2016 to July 2022. Data were collected on accuracy of the catheter placement, complications and outcome at 3 months assessed by mRS. The accuracy of the EVD placement was classified as optimal placement, sub-optimal placement and misplacement according to the position of the catheter tip. The complications reported are catheter-related hemorrhage, intracranial infection and hydrocephalus. There were 105 cases enrolled, with 72 patients in the iUS-guided group having 131 catheters inserted and 33 patients in the group where ultrasound was not used with a total of 59 catheters. 116 (88.55%) were optimally placed, 12 (9.16%) sub-optimal and 3 (2.29%) misplaced in the iUS-guided group, while 25 (42.37%) were in optimally placed, 30 (50.85%) sub-optimal and 4(6.78%) misplaced in the control group. Accuracy of placement was highly significantly improved using ultrasound (P < 0.001). The operation time and the average catheterized time were longer in the iUS-guided group (P < 0.05), but the complication rates were no different between the groups. The mRS at three months was not significantly different between the two groups. Using iUS to place EVD catheters in patients with severe IVH is a safe technique delivering more accurate catheter placement without increasing the complication rate compared with freehand placement.

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Primary intraventricular hemorrhage outcomes in the CLEAR III trial

Cited by 8 publications

References 22 publications

Intraventricular Hemorrhage Extension is a Strong Predictor of Mortality in Hemorrhagic Stroke

Intraventricular Hemorrhage Extension is a Strong Predictor of Mortality in Hemorrhagic Stroke

Impaired Kidney Function Portended a Bleak Prognosis for Surgically Treated Hypertensive Intracerebral Hemorrhage Patients

The accuracy and safety of intraoperative ultrasound-guided external ventricular drainage in intraventricular hemorrhage

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