Third Ventricle Obstruction by Thalamic Intracerebral Hemorrhage Predicts Poor Functional Outcome Among Patients Treated with Alteplase in the CLEAR III Trial
التفاصيل البيبلوغرافية
العنوان:
Third Ventricle Obstruction by Thalamic Intracerebral Hemorrhage Predicts Poor Functional Outcome Among Patients Treated with Alteplase in the CLEAR III Trial
INTRODUCTION: The Clot Lysis: Evaluating Accelerated Resolution of IVH (CLEAR III) trial examined whether irrigating the ventricular system with Alteplase improved functional outcomes in patients with small intracerebral hemorrhage (ICH) and large intraventricular hemorrhage (IVH). Thalamic ICH location was common and was associated with poor outcome. One possible explanation is thalamic ICH-associated mass effect obstructing the 3(rd) ventricle. We hypothesized that patients with thalamic ICH obstructing the 3(rd) ventricle would have worse functional outcomes compared to patients without obstructing lesions. METHODS: ICH obstruction of 3(rd) ventricle was defined as 3(rd) ventricle compression on 1 or more axial computed tomography slices visually impeding cerebral spinal fluid flow. If the 3(rd) ventricle was casted with IVH it was scored as such. Multivariable logistic regression analyses were used to determine whether obstruction of the 3(rd) ventricle predicts poor functional outcomes defined as modified Rankin score (mRS) 4–6, higher mRS, and mortality at 180 days. Models were adjusted for thalamic ICH location, ICH volume, IVH volume, age, hydrocephalus, baseline Glasgow coma scale, and percentage of low cerebral perfusion pressures during treatment. RESULTS: Among saline-treated patients obstruction of the 3(rd) ventricle by IVH was a significant predictor of higher mRS at 180 days (OR = 1.87, CI: 1.01–3.47), and mortality at 180 days (OR = 2.73, CI: 1.27–5.87) while obstruction by ICH was not. In contrast, among Alteplase-treated patients, obstruction by ICH was a significant predictor of mRS 4–6 (OR = 3.20, CI: 1.30–7.88) and higher mRS at 180 days (OR = 2.33, CI: 1.24–4.35), while obstruction by IVH was not. CONCLUSIONS: Poor outcomes were associated with mass-related obstruction of the 3(rd) ventricle from thalamic ICH in Alteplase-treated patients, and from IVH in saline-treated patients. Once the ventricular system is cleared with Alteplase, obstruction of cerebral spinal fluid flow from thalamic ICH might become important in functional recovery.
