Abstract Details

Title Refractory intracranial pressure elevation (ICP) treatment in acute aneurysmal subarachnoid hemorrhage via the novel neurapharesis CSF management system

Topic Neuro Trauma and Critical Care

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-004

Objective We present the novel use of the CSF Neurapheresis™ CSF Management System as a safe, controlled CSF diversion system to manage ICP elevation in acute aneurysmal subarachnoid hemorrhage.

Background Aneurysmal Subarachnoid Hemorrhage (aSAH) often presents with elevated intracranial pressure (ICP) and communicating hydrocephalus, resulting in increased morbidity/mortality. The PILLAR-XT clinical trial of the Neurapheresis™ CSF Management System (NP) (an automated lumbar drain with an option to divert blood/waste products and return filtered CSF) highlighted its ability to filter and reduce blood/contaminants in the CSF of aSAH patients. We present the novel use of NP as a safe, controlled CSF diversion system to manage ICP elevation in these patients.

Design/Methods After enrollment, NP was successfully placed in a 58-year-old female presenting with a high grade ruptured saccular aneurysm (PCoA, Hunt/Hess grade 4), which was coiled. Two days post-admission, the patient experienced refractory ICP elevation (>22mmHg) due to acute communicating hydrocephalus and aSAH. The neuro-intensivist adjusted CSF filtration and waste rates using the NP system to successfully treat ICP elevation. The patient was discharged home without complications and did not require a shunt.

Results This case illustrates the novel use of NP to control and manage ICP in acute aSAH while filtering blood/contaminants from the CSF.

Conclusions Patients with acute aSAH face high risk complications due to ICP-elevation, and directly related to rupture grade. Current standard of care offers tiers-based approach therapies for ICP management with the use of external ventricular devices (EVDs) for CSF diversion. EVDs are manual, non-specific, and prevent real-time ICP monitoring during CSF diversion, often resulting in incorrect drainage. PILLAR-XT highlighted the potential of NP as a tool for CSF diversion and filtration of RBCs/inflammatory-mediators that are instrumental in common secondary complications. This is the first case of utilizing NP device to divert and filter CSF and also concurrently treat ICP elevation.

Authors/Disclosures
Marc Alain Babi, MD (Cleveland Clinic Foundation (Florida Region)) PRESENTER	Dr. Babi has nothing to disclose.
Spiros Blackburn	Spiros Blackburn has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Christopher P. Kellner, MD (Mount Sinai Health System)	Dr. Kellner has stock in METIS Innovative. Dr. Kellner has stock in Precision Recovery. Dr. Kellner has stock in Synchron. Dr. Kellner has stock in Fluid BioMed. Dr. Kellner has stock in Proprio. Dr. Kellner has stock in Von Vascular. Dr. Kellner has stock in E8. Dr. Kellner has stock in Borvo. Dr. Kellner has stock in Phantom Neuro. Dr. Kellner has stock in Radical. Dr. Kellner has stock in Reach Neuro. Dr. Kellner has stock in Aurenar. The institution of Dr. Kellner has received research support from Integra. The institution of Dr. Kellner has received research support from Penumbra. The institution of Dr. Kellner has received research support from Viz.AI. The institution of Dr. Kellner has received research support from ICE Neurosystems. The institution of Dr. Kellner has received research support from Irras. The institution of Dr. Kellner has received research support from Microtransponder. The institution of Dr. Kellner has received research support from Medtronic. The institution of Dr. Kellner has received research support from Longeviti. The institution of Dr. Kellner has received research support from Endostream. The institution of Dr. Kellner has received research support from CVAID.

��ɫ��

��ɫ��