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Case report
Republished: Intraventricular thrombolysis after endovascular treatment of a ruptured arteriovenous malformation
  1. Arthur Wang1,
  2. Abhishek Ray2,
  3. Yin C Hu3
  1. 1Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
  2. 2Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA
  3. 3Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Yin C Hu, Department of Neurosurgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Hanna House, 5th Floor, Cleveland, OH 44106, USA; Yin.Hu{at}


Intraventricular haemorrhage (IVH) secondary to arteriovenous malformation (AVM) rupture carries significant morbidity and mortality. External ventricular drainage of IVH is frequently complicated by thrombus formation within the ventricular catheter and therefore often unsuccessful at treating hydrocephalus in this setting. Intraventricular administration of recombinant tissue-type plasminogen activator (rtPA) has proved successful in the treatment of spontaneous panventricular haemorrhage. However, usage of rtPA is contraindicated in the setting of a ruptured AVM or aneurysm in which the bleeding source has not been secured. There are only a few reports of intraventricular thrombolysis in the treatment of IVH from AVM rupture. We present the case of successful application of rtPA to treat IVH after endovascularly securing the haemorrhage site of the AVM. Intraventricular thrombolysis remains an option for the treatment of IVH in the setting of AVM rupture and should be considered on a case-by-case basis.

  • Arteriovenous Malformation
  • Thrombolysis
  • Hemorrhage
  • Ventricle

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  • Republished with permission from BMJ Case Reports Published 24 May 2016; doi:10.1136/bcr-2016-012408

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.