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Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter (PILLAR).

Publication ,  Journal Article
Blackburn, SL; Grande, AW; Swisher, CB; Hauck, EF; Jagadeesan, B; Provencio, JJ
Published in: Stroke
September 2019

Background and Purpose- The PILLAR (Extracorporeal Filtration of Subarachnoid Hemorrhage via Spinal Catheter) study is a first-in-human trial of cerebrospinal fluid (CSF) filtration in aneurysmal subarachnoid hemorrhage. The study evaluates the safety and feasibility of a novel filtration system to rapidly remove blood and blood breakdown products from CSF after securement of a ruptured aneurysm. Methods- Patients with aneurysmal subarachnoid hemorrhage had a dual-lumen lumbar, intrathecal catheter placed after aneurysm securement and received up to 24 hours of CSF filtration (neurapheresis therapy). The catheter aspirated blood-contaminated CSF from the lumbar cistern and returned filtered CSF to the thoracic subarachnoid space. Neuro checks were performed q2 hours, and CSF samples were collected for cell counts, total protein, and gram stain. Computed tomography scans were acquired at baseline and post-filtration. Clinical follow-up occurred at 2 weeks and 30 days. Results- Thirteen patients had a catheter placed (mean time 24:13 hours after ictus). The system processed 632.0 mL (180.6-1447.6 mL) CSF in 15:07 hours (5:32-24:00 hours) of filtration. The mean initial CSF red blood cell count, 2.78×105 cells/µL, reduced to 1.17×105 cells/µL after filtration (52.9% reduction), and total protein reduced 71%. Independent analysis of baseline and postfiltration computed tomographies found notable cisternal blood decrease, with 46.5% mean Hijdra Score reduction. Three mild, anticipated adverse events were reported. Conclusions- The initial safety and feasibility of Neurapheresis therapy in aneurysmal subarachnoid hemorrhage demonstrated the potential to safely filter CSF and remove blood and blood byproducts. Future studies are warranted. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT0287263.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

September 2019

Volume

50

Issue

9

Start / End Page

2558 / 2561

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Subarachnoid Hemorrhage
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Lumbosacral Region
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Blackburn, S. L., Grande, A. W., Swisher, C. B., Hauck, E. F., Jagadeesan, B., & Provencio, J. J. (2019). Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter (PILLAR). Stroke, 50(9), 2558–2561. https://doi.org/10.1161/STROKEAHA.119.025399
Blackburn, Spiros L., Andrew W. Grande, Christa B. Swisher, Erik F. Hauck, Bharathi Jagadeesan, and J Javier Provencio. “Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter (PILLAR).Stroke 50, no. 9 (September 2019): 2558–61. https://doi.org/10.1161/STROKEAHA.119.025399.
Blackburn SL, Grande AW, Swisher CB, Hauck EF, Jagadeesan B, Provencio JJ. Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter (PILLAR). Stroke. 2019 Sep;50(9):2558–61.
Blackburn, Spiros L., et al. “Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter (PILLAR).Stroke, vol. 50, no. 9, Sept. 2019, pp. 2558–61. Pubmed, doi:10.1161/STROKEAHA.119.025399.
Blackburn SL, Grande AW, Swisher CB, Hauck EF, Jagadeesan B, Provencio JJ. Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter (PILLAR). Stroke. 2019 Sep;50(9):2558–2561.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

September 2019

Volume

50

Issue

9

Start / End Page

2558 / 2561

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Subarachnoid Hemorrhage
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Lumbosacral Region
  • Humans
  • Female