BACKGROUND: Little is known about the efficacy of single versus dual extraventricular drain (EVD) use in intraventricular hemorrhage (IVH), with and without thrombolytic therapy. METHODS: Post-hoc analysis of seven patients with dual bilateral EVDs from two multicenter trials involving 100 patients with IVH, and spontaneous intracerebral hemorrhage (ICH) volume <30 ml requiring emergency external ventricular drainage. Seven "control" patients with single catheters were matched by IVH volume and distribution and treatment assignment. Head CT scans were obtained daily during intraventricular injections for quantitative determination of IVH volume. RESULTS: Median [min-max] age of the 14 subjects was 56 [40-73] years. Median duration of EVD was 7.9 days (single catheter group) versus 12.2 days (dual catheter group) (P = 0.34). Baseline median IVH volume was not significantly different between groups (75.4 ml [22.4-105.1]--single EVD vs. 84.5 ml [42.0-132.0]--dual EVD; P = 0.28). Comparing the change in IVH volume on time-matched CT scans during dual EVD use, the median decrease in IVH volume in dual catheter patients was significantly larger (52.1 [31.7-81.1] ml) versus single catheter patients (34.5 [13.1-73.9] ml) (P = 0.004). There was a trend to greater decrease in IVH volume during dual EVD use in both rt-PA (P = 0.9) and placebo-treated (P = 0.11) subgroups. CONCLUSION: The decision to place dual EVDs is generally reserved for large IVH (>40 ml) with casting and mass effect. The use of dual simultaneous catheters may increase clot resolution with or without adjunctive thrombolytic therapy.
RCT Entities:
BACKGROUND: Little is known about the efficacy of single versus dual extraventricular drain (EVD) use in intraventricular hemorrhage (IVH), with and without thrombolytic therapy. METHODS: Post-hoc analysis of seven patients with dual bilateral EVDs from two multicenter trials involving 100 patients with IVH, and spontaneous intracerebral hemorrhage (ICH) volume <30 ml requiring emergency external ventricular drainage. Seven "control" patients with single catheters were matched by IVH volume and distribution and treatment assignment. Head CT scans were obtained daily during intraventricular injections for quantitative determination of IVH volume. RESULTS: Median [min-max] age of the 14 subjects was 56 [40-73] years. Median duration of EVD was 7.9 days (single catheter group) versus 12.2 days (dual catheter group) (P = 0.34). Baseline median IVH volume was not significantly different between groups (75.4 ml [22.4-105.1]--single EVD vs. 84.5 ml [42.0-132.0]--dual EVD; P = 0.28). Comparing the change in IVH volume on time-matched CT scans during dual EVD use, the median decrease in IVH volume in dual catheter patients was significantly larger (52.1 [31.7-81.1] ml) versus single catheter patients (34.5 [13.1-73.9] ml) (P = 0.004). There was a trend to greater decrease in IVH volume during dual EVD use in both rt-PA (P = 0.9) and placebo-treated (P = 0.11) subgroups. CONCLUSION: The decision to place dual EVDs is generally reserved for large IVH (>40 ml) with casting and mass effect. The use of dual simultaneous catheters may increase clot resolution with or without adjunctive thrombolytic therapy.
Authors: N J Naff; J R Carhuapoma; M A Williams; A Bhardwaj; J A Ulatowski; J Bederson; R Bullock; E Schmutzhard; B Pfausler; P M Keyl; S Tuhrim; D F Hanley Journal: Stroke Date: 2000-04 Impact factor: 7.914
Authors: Kevin K Vereecken; Tony Van Havenbergh; Wim De Beuckelaar; Paul M Parizel; Philippe G Jorens Journal: Clin Neurol Neurosurg Date: 2005-08-31 Impact factor: 1.876
Authors: D Staykov; H B Huttner; J Lunkenheimer; B Volbers; T Struffert; A Doerfler; O Ganslandt; E Juettler; S Schwab; J Bardutzky Journal: J Neurol Neurosurg Psychiatry Date: 2010-01 Impact factor: 10.154
Authors: Daniel F Hanley; Karen Lane; Nichol McBee; Wendy Ziai; Stanley Tuhrim; Kennedy R Lees; Jesse Dawson; Dheeraj Gandhi; Natalie Ullman; W Andrew Mould; Steven W Mayo; A David Mendelow; Barbara Gregson; Kenneth Butcher; Paul Vespa; David W Wright; Carlos S Kase; J Ricardo Carhuapoma; Penelope M Keyl; Marie Diener-West; John Muschelli; Joshua F Betz; Carol B Thompson; Elizabeth A Sugar; Gayane Yenokyan; Scott Janis; Sayona John; Sagi Harnof; George A Lopez; E Francois Aldrich; Mark R Harrigan; Safdar Ansari; Jack Jallo; Jean-Louis Caron; David LeDoux; Opeolu Adeoye; Mario Zuccarello; Harold P Adams; Michael Rosenblum; Richard E Thompson; Issam A Awad Journal: Lancet Date: 2017-01-10 Impact factor: 79.321
Authors: Jennifer Jaffe; Eric Melnychuk; John Muschelli; Wendy Ziai; Timothy Morgan; Daniel F Hanley; Issam A Awad Journal: Neurosurgery Date: 2012-05 Impact factor: 4.654
Authors: J Kornbluth; S Nekoovaght-Tak; N Ullman; J R Carhuapoma; D F Hanley; W Ziai Journal: AJNR Am J Neuroradiol Date: 2015-07-30 Impact factor: 3.825