Intracisternal Recombinant Tissue Plasminogen Activator After Aneurysmal Subarachnoid Hemorrhage: Results of a Preliminary Study

Twenty-eight patients undergoing surgery within 48 hours of aneurysm rupture were administered recombinant tissue plasminogen activator (rt-PA) directly into the basal subarachnoid cisterns after minimal surgical clot removal and aneurysm clipping. Preoperatively, 26 patients had thick subarachnoid blood clots on computerized tomography (CT), and two had diffuse thin clots. The rt-PA was given as a single intraoperative injection of 7.5 mg (one patient), 10 mg (twenty-two patients), or 15 mg (five patients).