1375 Active Exchange of CSF for Rapid Removal of Blood in Hemorrhagic Stroke: Multicenter Experience in 40 Patients

INTRODUCTION: Intraventricular hemorrhage (IVH) often complicates spontaneous intracerebral hemorrhage (ICH) and subarachnoidal hemorrhages (SAH), leading to increased mortality and morbidity. Neuroinflammation resulting from blood organization in cerebrospinal fluid (CSF) contributes to poor outcomes. METHODS: Data were collected from six leading centers in the EU and USA utilizing the new active EVD system. Forty patients were analyzed, including those with SAH, spontaneous ICH-related IVH, and vascular anomaly-related hemorrhage. Blood removal from the ventricular system was assessed using computed tomography (CT) imaging, and shunt dependency was calculated for SAH patients using CHESS scores. RESULTS: Active EVD facilitated safe and effective blood removal from the CSF system. The pace of blood removal correlated with irrigation volume. Spontaneous ICH patients achieved a median IVH clearance of 91.3% following an average treatment duration of 7.6 days. SAH patients exhibited lower shunt dependency (2) compared to literature and expected values (11) based on CHESS scores. Vascular anomaly patients achieved a median IVH clearance of 91.3% after an average treatment of 8 days. No CSF exchange-related infections were reported. CONCLUSIONS: Active EVD enables accelerated blood removal from the CSF system, reducing adverse events in hemorrhagic stroke patients. The rate of blood removal is closely tied to the irrigation rate. Prospective trials are warranted to identify the patient population most benefiting from CSF exchange during hemorrhagic stroke treatment.