Effect of Intraventricular tPA Following Aneurysmal Subarachnoid Hemorrhage
Effect of Intraventricular tPA Following Aneurysmal Subarachnoid Hemorrhage
This study will evaluate the hypothesis that the administration of intraventricular tPA
 reduces the rates of cerebral vasospasm and ventriculoperitoneal shunt-dependent
 hydrocephalus in patients with aneurysmal subarachnoid hemorrhage.
Inclusion Criteria:

 -  Age greater than 18 years old.

 -  SAH due to aneurysm, as determined by CT angiogram or cerebral angiogram.

 -  Modified Fisher (mF) grade 3 or 4 SAH, defined as thick cisternal blood without (grade
 3) or with (grade 4) intraventrciular blood.

 -  Exclusion of the aneurysm from the parent circulation by endovascular embolization
 (Raymond class I or II) within 48 hours of ictus.

 -  Ventriculostomy placement must occur prior to randomization.

 -  Informed consent obtained from the patient or patient's decision maker

 Exclusion Criteria:

 -  Determination by treating physician(s) that no ventriculostomy is needed.

 -  Presence of intrinsic clotting disorders (e.g. due to hepatic failure, nephrotic
 syndrome, etc). Subjects whose pharmacologic anticoagulation is reversed, as
 determined by PT/INR, PTT within our institution's normal range, will be permitted to
 participate in this study.

 -  Presence of significant anemia, defined as hemoglobin < 8 gm/dL.

 -  Patients who undergo endovascular techniques requiring post-operative dual
 anti-platelet therapy.

 -  Residual aneurysm sac filling (Raymond class III occlusion).

 -  Aneurysm or vessel perforation during the endovascular procedure.

 -  Presence of craniectomy.

 -  Significant neurologic disability prior to the onset of SAH.

 -  Determination that administration of tPA/placebo cannot be initiated within 72 hours
 of symptom onset.

 -  Presence of untreated intracranial aneurysms larger than 3mm on CT angiography or
 cerebral angiogram.