Develop the different patterns of collapse. Help better understand the EVD catheter and it s effect on the ICH

Transcription

1 Ryan Noel Fisico

2 Develop the different patterns of collapse Help better understand the EVD catheter and it s effect on the ICH

3 End of Treatment Patient CT Post- Surgery CT Reposition Timeline

4 Stability CT Scan Post-Surgery Scan Reposition CT Scan* End of Treatment Scan * Only if a reposition of the catheter was made

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6 Stability CT Scan 26-Jul-08 12:00 Stability Volume: EOT Volume: % Reduction: Catheter Score: 76 Post-Surgery CT Scan 26-Jul-08 21:26 End of Treatment Scan 30-Jul-08 22:04

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11 Ports

12 Codman Regular/Codman Trauma Codman Bactiseal Integra Medtronic Kabula Hummingbird

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14 Gathered from patients with a Catheter score above 70 (50 patients). Generalized to 67 MISTIE II surgical patients* Type 1 Collapse of ICH around catheter Type 2 ICH Anterior Narrowing Type 3 ICH Posterior Narrowing Type 4 Inside-Out *4 patients with rebleeding (negative reduction of Intracerebral Hemorrhage) were not included. 10 patients with zero dosing were not included.

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16 Narrowing or shrinkage of ICH

17 Stability CT Scan 04-Mar-10 8:41 Stability Volume: EOT Volume: 7.08 % Reduction: Catheter Score: Post-Surgery CT Scan 05-Mar-10 17:21 End of Treatment Scan 07-Mar-10 10:20

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20 There is narrowing or complete depletion of ICH on the anterior portion.

21 Stability CT Scan 26-Jul-08 12:00 Stability Volume: EOT Volume: % Reduction: Catheter Score: 76 Post-Surgery CT Scan 26-Jul-08 21:26 End of Treatment Scan 30-Jul-08 22:04

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23 Stability CT Scan 12-Dec-08 21:01 Stability Volume: EOT Volume: % Reduction: Catheter Score: 95 Post-Surgery CT Scan 13-Dec-08 16:45 End of Treatment Scan 16-Dec-08 8:31

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26 There is narrowing or complete depletion of ICH on the posterior portion.

27 Stability CT Scan 19-Feb-07 20:36 Stability Volume: EOT Volume: % Reduction: Catheter Score: 56 Post-Surgery CT Scan 20-Feb-07 10:04 End of Treatment Scan 22-Feb-07 3:51

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29 Stability CT Scan 12-Nov-08 2:16 Stability Volume: EOT Volume: % Reduction: Catheter Score: 55 Post-Surgery CT Scan 13-Nov-08 2:24 End of Treatment Scan 15-Nov-08 6:27

30 Post-Surgery CT Scan 13-Nov-08 20:15 Stability Volume: EOT Volume: % Reduction: Catheter Score: 55 End of Treatment Scan 15-Nov-08 6:27 initial placement shown on 11/13 02:26, pulled back shown on 11/13 20:15-4

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33 The ICH drains in the opposite way creating a hole around the catheter.

34 Stability CT Scan 11-Jun-09 8:26 Stability Volume: EOT Volume: % Reduction: Catheter Score: Post-Surgery CT Scan 11-Jun-09 14:37 End of Treatment Scan 15-Jun-09 4:15

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37 Total of 78 Patients Collapse 43/78 Anterior Narrowing 11/78 Patterns of Collapse Collapse Anterior Posterior Inside-Out Zero Dosing 13% (10) Posterior Narrowing 4/78 Inside-Out 10/78 Zero Dosing 10/78 13% (10) 5% (4) 14% (11) 55% (43) n=67

38 Total of 67 Patients* Patterns of Collapse Collapse Anterior Posterior Inside-Out Collapse 42/67 Anterior Narrowing 11/67 Posterior Narrowing 4/67 15% (10) 6% (4) Inside-Out 10/67 Zero Dosing 10 16% (11) 63% (42) *Did not count 2 patients because of rebleeding and 10 patients with zero dosing n=67

39 Percent Amount of Reduction by Pattern of Collapse % 80.00% 60.00% 73.73% 57.44% 58.35% 56.67% 57.93% 40.00% 38.01% 20.00% 0.00% Overall Collapse Anterior Posterior Inside- Out Zero Dosing % 57.44% 58.35% 56.67% 57.93% 73.73% 38.01% n=77 n=42 n=11 n=10 n=10 n=4

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41 Type A - Patterns of Collapse Type 1 (Collapse): 16/24 Type 2 (Anterior): 5/24 Type 3 (Posterior): 0 Type 4 (Inside-Out): 3/24 Zero Dosing 1 Collapse Posterior 12% (3) 12% 21% (5) Anterior Inside-Out 67% (16) n=24

42 Type B Patterns of Collapse Collapse Anterior Posterior Inside-Out Type 1 (Collapse): 8/14 Type 2 (Anterior): 1/14 Type 3 (Posterior): 1/14 7% (1) Type 4 (Inside Out): 4/14 Zero Dosing 2 29% (4) 7% (1) 57% (8) n=14

43 Type C Patterns of Collapse Collapse Anterior Posterior Inside-Out Type 1 (Collapse): 18/29 Type 2 (Anterior): 5/29 10% (3) Type 3 (Posterior): 3/29 10% (3) Type 4 (Inside Out): 3/29 Zero Dosing 7 18% (5) 62% (18) n=29

44 Percentage 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Type A, B, and C Comparison Type A Type B Type C Inside-Out Posterior Anterior Collapse n=24 n=14 n=29

45 Total of 29 Type C s* Horizontal (C1) 11/29 Hor izontal approach is when the catheter is placed in the same plane as the CT slice. Type C Classification Horizontal Vertical 17/36 Vertical (C2) 18/29 Ver tical approach is when the catheter intersects the plane of the CT slice. 62% (18) 38% (11) *Did not count 2 patients because of rebleeding and 10 patients with zero dosing n=29

46 Type 1 (Collapse): 9/11 C1 Patterns of Collapse Collapse Anterior Posterior Inside-Out 9% (1) Type 2 (Anterior): 1/11 Type 3 (Posterior): 1/11 9% (1) 9% Type 4 (Inside Out): 0/11 Zero Dosing 6 82% (9) n=11

47 C2 Patterns of Collapse Type 1 (Collapse): 9/18 Type 2 (Anterior): 4/18 Type 3 (Posterior): 2/18 Type 4 (Inside Out): 3/18 Zero Dosing 1 Collapse Inside-Out 11% (2) 17% (3) 22% (4) Anterior Posterior 50% (9) n=18

48 Percentage Type C Patterns of Collapse 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% C1 C2 Inside-Out 0 3 Posterior 1 2 Anterior 1 4 Collapse 9 9 n=11 n=18

49 Percentage Amount of Reduction of Overall in Relation to C % and C2 Type C Patients 80.00% 60.00% 40.00% 60.34% 50.89% 56.69% 20.00% 0.00% Overall C1 C2 % 60.34% 50.89% 56.69% n=67 n=11 n=18

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51 Stability CT Scan 28-Feb-11 4:52 Stability Volume: EOT Volume: % Reduction: Catheter Score: 28 Post-Surgery CT Scan 02-Mar-11 2:38 End of Treatment Scan 03-Mar-11 8:52

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53 Zero Dosing Clot Removal Success Clot Removal Failure Less than 15 CC s at EOT Greater than 60% reduction

54 Stability Volume: Resting Volume: 12.3 % Reduction: Catheter Score: 58 Stability Volume: 55.9 Resting Volume: % Reduction: Catheter Score: 52 Stability Volume: Resting Volume: 7.63 % Reduction: Catheter Score: 35 Randomized

55 Stability Volume: 42.4 Resting Volume: % Reduction: Catheter Score: 40 Stability Volume: Resting Volume: % Reduction: Catheter Score: 74 Stability Volume: Resting Volume: % Reduction: Catheter Score: 47 Stability Volume: Resting Volume: % Reduction: Catheter Score: 55 Stability Volume: 70.7 Resting Volume: 57.2 % Reduction: Catheter Score: 46 Stability Volume: Resting Volume: % Reduction: Catheter Score: 95 Stability Volume: Resting Volume: % Reduction: Catheter Score: 28 Run-in Randomized

56 More than half of the time, the ICH will narrow around the catheter. Inside-Out Pattern commonly found in C2 approach and Type B patients Anterior, Inside-Out, and Posterior are examples of hemorrhages in which the rtpa did not spread equally More Zero Dosing with C1 approach as well as the lower reduction percentage may indicate a less-effective approach Partitioned Narrowing (Anterior and Posterior) may be indicative of the effects of gravity Type C patients with Vertical approach have higher possibility of anterior or posterior narrowing and Inside- Out effect.