803 Extracorporeal Filtration of Blood and Blood Breakdown Products from CSF via Spinal Catheter (PILLAR-XT) Following Aneurysmal Subarachnoid Hemorrhage

Abstract

INTRODUCTION: Delayed cerebral ischemia (DCI) is a secondary injury of aneurysmal subarachnoid hemorrhage (aSAH), and is considered to be related to blood and blood breakdown products (BBPs) in the CSF. Previously, bulk drainage of CSF post-aSAH via lumbar drain appeared to result in decreased DCI. If inflammation related to BBPs plays a role in DCI, accelerating removal of BBPs following aSAH could be of significant therapeutic benefit. This study evaluated a system designed to accelerate removal by rapidly filtering BBPs from CSF while returning filtered CSF to the patient via a dual lumen catheter and extracorporeal filtration system (Neurapheresis™ System). METHODS: Patients with aSAH had a dual lumen lumbar, intrathecal catheter placed after aneurysm securement and received up to 72±4 hours Neurapheresis therapy. The catheter aspirated blood-contaminated CSF from the lumbar cistern and returned filtered CSF to the thoracic subarachnoid space, routing BBPs to a waste bag. RESULTS: Of 7 males (24.1%) and 22 females (75.9%), a catheter was successfully placed in 27 subjects out of 29 attempts (93.1% success rate. The mean duration of treatment was 34:18 hrs [3:39 – 62:17] (n=27), and the system maintained its expected, controlled, safe drainage rate, mean 6.5 ml/hr [2.1 – 12.5] (n=27). Mean paired RBC values in CSF (106/mm3) declined by 84.5±22.3% (n=21) by the end of treatment. Mean paired total protein (mg/dL) declined by 85.3±8.3% (n=21) to within normal range. Paired Hijdra Sum Scores (sum of ten cistern blood fullness scores - maximum score: 30) declined by 60.1±24.1% (n=25); the largest decline was noted between catheter placement and catheter removal. CONCLUSIONS: In this feasibility study, Neurapheresis was associated with a decline in RBC and protein concentration in CSF, and improvement in blood clearance as measured by Hijdra Sum Scores. The procedure was safe and well tolerated in this study.