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The extracorporeal filtration of subarachnoid hemorrhage via spinal catheter extension study evaluated the safety, tolerability, and filtration curve of blood and its lysis products from hemorrhagic CSF using the Neurapheresis CSF Management System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After aneurysm repair, a dual-lumen intrathecal catheter was inserted into the study participant\u2019s spinal canal. CSF was extracorporeally filtered for up to 72\u00a0h, removing blood products from the lumbar cistern, and reintroducing filtered CSF to the thoracic subarachnoid space. Neurological examinations were performed every 2\u00a0h, computed tomography scans were captured five times, and CSF samples were evaluated for cell counts every 8\u00a0h. Clinical follow-up evaluations were conducted 2 and 30\u00a0days after treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven of 29 study participants (93%) had a catheter successfully inserted. The median rate of waste removal was 5.7\u00a0mL\/hr (interquartile range 3.9\u20138.8), and the median CSF filtration duration was 37:00\u00a0h (interquartile range 24:03\u201338:52). CSF red blood cell (mean reduction of 86%) and protein cell counts (mean reduction of 82%) decreased much faster in Neurapheresis system\u2013treated participants compared with published data from standard-of-care patients with aneurysmal subarachnoid hemorrhage. From study participant screening through catheter removal, intracranial blood (evaluated via Hijdra Sum Score) decreased by 65%. In four study participants, there were a total of five adverse events, among whom one was determined per protocol to be a serious adverse event. All five events were mild or moderate severity and resolved with no clinical sequelae.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Extracorporeal Filtration of Subarachnoid Hemorrhage Via Spinal Catheter Extension study demonstrated the potential to significantly accelerate intracranial blood elimination based on imaging (Hijdra Sum Score) and CSF red blood cell and protein reduction measures via a closed-loop filtration system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-025-02328-8","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T19:14:45Z","timestamp":1753989285000},"page":"934-946","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage via Lumbar Catheter Extension (PILLAR-XT)"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2902-5079","authenticated-orcid":false,"given":"Spiros L.","family":"Blackburn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Babi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew W.","family":"Grande","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A.","family":"Choudhri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik F.","family":"Hauck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Kellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Giordano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivanand P.","family":"Lad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron R.","family":"McCabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"issue":"9","key":"2328_CR1","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1007\/s00701-020-04463-x","volume":"162","author":"LR \u00d8ie","year":"2020","unstructured":"\u00d8ie LR, Solheim O, Majewska P, Nordseth T, M\u00fcller TB, Carlsen SM, et al. 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Dr. Omar Choudhri is consultant for Medtronic neurovascular, Microvention, Q\u2019apel, Balt and Siemens Healthineers. Dr. Kellner receives grant support from Integra, Penumbra, Viz.AI, Siemens, Medtronic, Minnetronix, Longeviti, Irras, ICE Neurosystems, CVAID, Endostream, and Microtransponder; and has equity in Precision Recovery, Borealis, E8, Borvo, and Metis Innovative. Mr. Giordano and Dr. McCabe are full time employees of Minnetronix Medical. Dr. Lad is a Senior Medical Advisor, Minnetronix Medical. Dr. McCabe was the PI on National Institutes of Health SBIR Grant R44NS110247, which provided study funding.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}},{"value":"The Extracorporeal Filtration of Subarachnoid Hemorrhage Via Spinal Catheter Extension trial made use of a central institutional review board (IRB), Western IRB (now WCG) for overall approval, while coordinating with local site IRBs for site approval. All study participants were consented prior to participation in the trial.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval\/Informed Consent"}},{"value":"ClinicalTrials.gov: NCT03607825.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical Trial Registration"}}]}}