J Neurosurg 143:928–938, 2025
Active blood clearance and prevention of delayed cerebral ischemia (ABCD) after aneurysmal subarachnoid hemorrhage significantly reduced delayed cerebral infarction rates and improved outcomes in high-risk patients, using methods like intrathecal irrigation, urokinase, and nimodipine, according to a 16-year registry study.
Active blood clearance and prevention of delayed cerebral ischemia (ABCD) was introduced for patients with aneurysmal subarachnoid hemorrhage (aSAH) to reduce delayed cerebral infarction (DCI) using methods like intrathecal irrigation, fibrinolysis with urokinase, and intrathecal nimodipine.
• Four ABCD methods were developed: stereotactic catheter ventriculocisternostomy (STX-VCS), intraoperative cisternoventricular catheter (CVC), ventriculolumbar irrigation (VLI), and lumbo-lumbar irrigation (LLI).
• Implementation of ABCD in high-risk patients led to a significant reduction in DCI rates from 21.2% to 7.7% and a 70% decrease in per-patient DCI burden.
• Patients selected for ABCD had higher initial blood load and worse clinical status, but still showed improved outcomes, especially those with high Hijdra scores (≥30).
• Pressure-controlled VLI and intraoperative CVC emerged as the most practical and widely applicable ABCD techniques.
• Complication rates were low and ABCD was considered safe, with rare adverse events and no increase in infection rates.
• The study suggests ABCD outperforms previous DCI prevention strategies and recommends multicenter trials for further validation.
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