Two-Dimensional Transthoracic Echocardiographic Demonstration of Reduction in Fibrin Content in Purulent Pericarditis Following Intrapericardial Fibrinolytic Agent Administration

We describe an adult patient who presented with purulent pericarditis in whom two-dimensional transthoracic echocardiography demonstrated a marked decrease in the area of the right ventricular wall together with the overlying fibrin following intrapericardial administration of a fibrinolytic agent. Documentation of this decrease by measurements performed and illustrated on two-dimensional images have not been reported previously in an adult patient with purulent pericarditis, to the best of our knowledge.

Recirculatory Fibrinolytic-Assisted External Ventricular Drainage (EVD) for Intraventricular Hemorrhage

Background Elevated intracranial pressure and acute obstructive hydrocephalus secondary to intraventricular hemorrhage (IVH) can be treated by external ventricular drainage (EVD). The treatment time and the risk of EVD-related complications can be reduced with fibrinolytic agents’ instillation via an EVD catheter, but previous clinical trial results did not reveal a significant improvement in terms of long-term functional outcomes. A recirculatory fibrinolytic-assisted EVD system was designed. The clot dissolution effectiveness of the system under different drug dosages and fluid flow rates was tested in an ex vivo model. Results The results showed that the mean clot mass was quickly reduced in an initial fibrinolytic agent dose-independent stage, followed by a dose-dependent stage. Elevating fibrinolytic agent dosages beyond a certain threshold did not contribute to shorter dissolution times. Optimal treatment parameters for such a system were determined. A recirculatory flow rate of 10–18 ml/min with a low-dose of 30 000–60 000 IU of uPA resulted in an 80% clot mass reduction within four hours. Conclusions This recirculating fibrinolytic system is a promising novel modification of conventional IVH treatment that could reduce clot dissolution times and procedure-related complications.

Reversal of intraoperative arterial thrombosis with a fibrinolytic agent when treating large and giant partially thrombosed aneurysms of the middle cerebral artery

OBJECT Thrombosis of the cerebral arteries is one of the complications of microsurgical operations for partially thrombosed intracranial aneurysms. The object of this study was to assess the frequency of intraoperative arterial thrombosis (IAT) during microsurgical treatment of large and giant partially thrombosed aneurysms of the middle cerebral artery (MCA) and also to assess the efficacy of the treatment of this complication. MATERIALS The authors analyzed a consecutive series of 53 patients who underwent surgery for partially thrombosed aneurysms of the MCA at the Burdenko Neurosurgical Institute between January 2005 and September 2014. Thirty-two patients had large aneurysms (15–25 mm) and 21 had giant aneurysms (> 25 mm). Clipping of aneurysms was performed in 47 patients, trapping was performed in 3, and wrapping was performed in 3. RESULTS IAT was diagnosed in 10 patients (18.9%). The authors describe a technique for IAT reversal involving the injection of modified human recombinant prourokinase (mr-proUK). Of the 7 patients who underwent injection of mr-proUK in the thrombosed artery, 5 (71.4%) were discharged without any change in neurological status, 1 (14.3%) experienced moderate deterioration (modified Rankin Scale [mRS] score of 2), and 1 (14.3%) experienced severe deterioration (mRS score of 4). Among the 3 patients who had complications and did not receive an injection of mr-proUK, 2 experienced severe deterioration (mRS score of 3 and 4) and 1 had moderate deterioration (mRS score of 2). CONCLUSIONS The primary risk factor of thrombectomy with temporary trapping is thrombosis in the MCA branches. The injection of a fibrinolytic agent into thrombosed MCA branches is an effective method for the treatment of IAT.