Induced Suppression of Platelets Activity in Aneurysmal SAH Management (iSPASM)

Inclusion Criteria

• Age ≥ 18 and ≤ 85 years
• Hunt and Hess scale ≤ 4 at time of admission or following EVD placement.
• CT showing modified Fisher grade 1-4 aSAH on admission.
• The Modified Fisher CT rating scale: Grade 1 (minimal or diffuse thing SAH without IVH); Grade 2 (minimal or thin SAH with IVH), Grade 3 (thick cisternal clot without IVH), Grade 4 (thick cisternal clot with IVH)
• Placement of EVD on admission.
• Diagnosis of aSAH occurred 24 post embolization.
• Multiple aneurysms that may have been untreated and a potential etiology for rupture.
• Femoral arteriotomy stick above the inferior epigastric artery OR angiographic, CT, or clinical evidence of an arteriotomy related retroperitoneal hematoma or large flank hematoma. A stable groin hematoma is not an exclusion.
• Thrombocytopenia (platelet count less than 100, 000 - assuming clumping has been ruled out as a cause), confirmed active disseminated intravascular coagulation (DIC) at the time of enrollment OR a documented history of coagulopathy or bleeding diathesis.
• New parenchymal hemorrhage or new infarction larger the 15cc in volume (clinically significant), or worsening midline shift as seen on the post-coiling, pre-enrollment head CT when compared to baseline admission head CT. New hyperdensity on CT scan related to contrast staining is not an exclusion.
• Patient developed SAH-induced cardiac stunning prior to enrollment, with an ejection fraction 2 x normal.
• Creatinine clearance 150 kg (due to the lack of safety data)
• 2 or more passes for the ventricular catheter at time of placement.