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Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage.
Barrett, Ryan J; Hussain, Rahat; Coplin, William M; Berry, Samera; Keyl, Penelope M; Hanley, Daniel F; Johnson, Robert R; Carhuapoma, J Ricardo.
Afiliação
  • Barrett RJ; Department of Neurosurgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
Neurocrit Care ; 3(3): 237-45, 2005.
Article em En | MEDLINE | ID: mdl-16377836
INTRODUCTION: To test the feasibility and safety of a minimally invasive technique, we report our experience in treating spontaneous intracerebral hemorrhage (ICH) patients by using frameless stereotactic clot aspiration-thrombolysis and its effects on their 30-day survival. We compared the observed cohort mortality with its predicted 30-day ICH mortality, by using previously validated methods. METHODS: Selection criteria were diagnosis of hypertensive ICH > or =35 cc, reduced level of consciousness, and no brainstem compression. Frameless stereotactic puncture/clot aspiration followed by intraclot external catheter placement was performed. Two milligrams of recombinant tissue plasminogen activator (rtPA) was administered q12 hours until ICH volume < or =10 cc, or the catheter fenestrations were no longer in continuity with the clot. RESULTS: Fifteen patients were treated, mean age was 60.7 years. Hemorrhage locations included basal ganglia (13), thalamic (1), and lobar (1); mean systolic blood pressure; and admission ICH volumes were 229.3 mmHg and 59.1 cc, respectively. Median time from ictus to clot aspiration/thrombolysis was 1 (range 0-3) day. Mean hematoma volume was reduced to 17% of pretreatment size. Complications were ventriculitis (6.6%) and clot enlargement (13.3%). Two patients were dead at 30 days. Median Glasgow Coma Scale (GCS) scores were 10.5 (4-15) at admission and 11.0 (3-15) at discharge. By using the most conservative estimate for analysis, probability of observing two or fewer deaths among 15 patients with an overall probability of dying calculated at 0.33 was p = 0.079. CONCLUSIONS: In this selected cohort of patients with ICH, stereotactic aspiration and thrombolytic washout seemed to be feasible and to have a trend towards improved 30-day survival, when using their predicted mortality data as "historical control." Complications did not exceed expected incidence rates. Based on the experience presented here as well as previous similar reports, a larger, randomized study addressing dose escalation, patient selection, and best therapeutic window is needed.
Assuntos
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Base de dados: MEDLINE Assunto principal: Terapia Trombolítica / Hemorragia Cerebral / Trombose Intracraniana Tipo de estudo: Clinical_trials / Prognostic_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Neurocrit Care Assunto da revista: NEUROLOGIA / TERAPIA INTENSIVA Ano de publicação: 2005 Tipo de documento: Article País de afiliação: Estados Unidos
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Base de dados: MEDLINE Assunto principal: Terapia Trombolítica / Hemorragia Cerebral / Trombose Intracraniana Tipo de estudo: Clinical_trials / Prognostic_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Neurocrit Care Assunto da revista: NEUROLOGIA / TERAPIA INTENSIVA Ano de publicação: 2005 Tipo de documento: Article País de afiliação: Estados Unidos