Active Blood Clearance and Delayed Cerebral Ischemia Prevention Therapy Reduces Shunt-Dependent Hydrocephalus in Patients With Aneurysmal Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVES: Chronic shunt-dependent hydrocephalus (CSH) is a common and serious complication after aneurysmal subarachnoid hemorrhage (aSAH). Active blood clearance and delayed cerebral ischemia prevention (ABCD) therapy, using intrathecal urokinase and nimodipine irrigation, aims to enhance blood clearance and prevent vasospasm. This study evaluates whether ABCD therapy reduces the incidence of CSH in aSAH patients. METHODS: A matched-pairs analysis was performed and 160 aSAH patients who had received ABCD therapy were compared with 160 controls. Patients were paired on the basis of a best fit model including the World Federation of Neurological Surgeons grade, age, cerebral herniation, intracerebral hemorrhage, and the initial Hijdra score. Patients were stratified by Hijdra score to account for blood load. The incidence of CSH was compared between groups using χ 2 tests, whereas a multivariable cause-specific Cox proportional hazards model was used to assess time to shunt-dependent hydrocephalus. In addition, multivariate logistic regression was performed to identify predictors of hydrocephalus. RESULTS: The incidence of CSH was significantly lower in the ABCD group (19.4%) compared with the standard care group (31.3%, P = .015). Subgroup analysis revealed that patients with the highest blood load (Hijdra 30-42) experienced a significant reduction in hydrocephalus (45.8% vs 22.5%, P = .026). By contrast, no significant effects were observed in patients with lower Hijdra scores. Multivariate analysis confirmed that the Hijdra score was a significant predictor of CSH in the standard care group ( P = .008) but not in the ABCD-treated group ( P = .843). CONCLUSION: aSAH patients selected for ABCD therapy had a significantly lower incidence of shunt-dependent hydrocephalus compared with matching controls. ABCD therapy may be an important preventive strategy in patients with severe subarachnoid hemorrhage.