Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
18 Sep 2023
18 Sep 2023
Historique:
received:
27
06
2023
accepted:
27
07
2023
medline:
18
9
2023
pubmed:
18
9
2023
entrez:
18
9
2023
Statut:
aheadofprint
Résumé
Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes. We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses. Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis. Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes.
METHODS
METHODS
We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses.
RESULTS
RESULTS
Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis.
CONCLUSION
CONCLUSIONS
Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.
Identifiants
pubmed: 37721435
doi: 10.1227/neu.0000000000002687
pii: 00006123-990000000-00891
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Foundation for the National Institutes of Health
ID : K23NS105948
Organisme : Foundation for the National Institutes of Health
ID : 5U01NS062851
Organisme : Foundation for the National Institutes of Health
ID : 5U01NS062851
Organisme : Foundation for the National Institutes of Health
ID : 5U01NS062851
Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167-176.
Sheth KN. Spontaneous intracerebral hemorrhage. N Engl J Med. 2022;387(17):1589-1596.
Yogendrakumar V, Ramsay T, Fergusson D, et al. New and expanding ventricular hemorrhage predicts poor outcome in acute intracerebral hemorrhage. Neurology. 2019;93(9):e879–e888.
Dey M, Jaffe J, Stadnik A, et al. External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2012;12(1):24-33.
Mahto N, Owodunni OP, Okakpu U, et al. Postprocedural complications of external ventricular drains: a meta-analysis evaluating the absolute risk of hemorrhages, infections, and revisions. World Neurosurg. 2023;171:41-64.
Murthy SB, Moradiya Y, Shah J, et al. Incidence, predictors, and outcomes of ventriculostomy-associated infections in spontaneous intracerebral hemorrhage. Neurocrit Care. 2016;24(3):389-396.
Gardner PA, Engh J, Atteberry D, et al. Hemorrhage rates after external ventricular drain placement. J Neurosurg. 2009;110(5):1021-1025.
Muller A, Mould WA, Freeman WD, et al. The incidence of catheter tract hemorrhage and catheter placement accuracy in the CLEAR III trial. Neurocrit Care. 2018;29(1):23-32.
Binz DD, Toussaint LG 3rd, Friedman JA. Hemorrhagic complications of ventriculostomy placement: a meta-analysis. Neurocrit Care. 2009;10(2):253-256.
Kakarla UK, Chang SW, Theodore N, et al. Safety and accuracy of bedside external ventricular drain placement. Oper Neurosurg. 2008;63(1):ons162-ons167; discussion ONS66-7.
Jackson DA, Patel AV, Darracott RM, et al. Safety of intraventricular hemorrhage (IVH) thrombolysis based on CT localization of external ventricular drain (EVD) fenestrations and analysis of EVD tract hemorrhage. Neurocrit Care. 2013;19(1):103-110.
Rowe AS, Rinehart DR, Lezatte S, et al. Intracerebral hemorrhage after external ventricular drain placement: an evaluation of risk factors for post-procedural hemorrhagic complications. BMC Neurol. 2018;18(1):22.
Majmundar N, Sarris C, Shastri D, et al. Hemorrhagic complications of external ventriculostomy in the aspirin and P2Y12 response assay era. World Neurosurg. 2019;122:e961-e968.
Shah VA, Thompson RE, Yenokyan G, et al. One-year outcome trajectories and factors associated with functional recovery among survivors of intracerebral and intraventricular hemorrhage with initial severe disability. JAMA Neurol. 2022;79(9):856-868.