Subarachnoid Clot Clearance Using Intermittent Intracisternal Urokinase Injection Therapy Combined with Arachnoid Plasty

Abstract

To evaluate the efficacy and safety of intermittent intracisternal urokinase (UK) injection therapy used in combination with arachnoid plasty (AP) on subarachnoid clot clearance (SCC), we retrospectively analyzed serial computed tomography (CT) findings in 40 patients presenting with Fisher Group 3 subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms in anterior circulation. SCC was evaluated using average CT number and the Hijdra CT scoring system for each basal cistern. The average clearance rate (CR) on postoperative Day 4 exceeded 80% in most areas of the basal cistern whereas in areas where residual clots were mainly observed (distal sylvian- and interhemispheric fissures), CR was approximately 50 to 60%. The incidence of symptomatic vasospasm (SVS) [total (T)-SVS＝17.5%; irreversible (I)-SVS＝7.5%] was lower than in our historical controls during the past three years (2004–2006) (T-SVS＝31.0%; I-SVS＝23.8%) and reported observations (T-SVS＝29.0–32.0%).
Despite inherent technical limitation, our protocol for UK injection with AP is simple and labor-saving. Data in the present study suggest that our protocol is an effective approach for early SCC at least in and around the basal cistern, and that it may be of value in preventing SVS when employed in combination with other multimodal therapeutic approaches.