CLEAR Intraventricular Hemorrhage

See related article, pages 3009–3016.Stroke unit care, intravenous thrombolysis, and endovascular treatment of acute ischemic stroke have changed stroke medicine dramatically. In the past decades, the chances of surviving acute ischemic stroke without severe handicap have increased substantially for the majority of stroke patients. However, the outlook for patients with intracerebral hemorrhage is still gloomy. There has been only little progress for treatment of acute intracerebral hemorrhage.Cerebral hemorrhage that is not related to trauma or coagulopathy, neoplasm, or vasculopathy accounts for 10% to 20% of the stroke burden worldwide. Treatment of arterial hypertension is the most effective means to reduce this part of the stroke burden. Both primary and secondary preventive studies have shown the effectiveness of blood pressure lowering to decrease the risk of so-called spontaneous or primary hemorrhage.1,2 Nevertheless, acute intracerebral bleedings do occur, even if prevention is optimized.Several interventions in the acute stage that aimed at reduction of hematoma enlargement, improvement of perihematoma perfusion and hypometabolism, and reduction of vasogenic edema raised hope that modern medicine would become effective to improve outcome after cerebral hemorrhage. This hope was generated because of uncontrolled or small randomized studies, but it did not come true after larger trials. The most illustrative examples are the phase II and phase III trials with recombinant factor VIIa.3,4 Treatment with recombinant factor VIIa within 4 hours after the onset of intracerebral hemorrhage limited the growth …