Stereotactic Computed Tomographic–Guided Aspiration and Thrombolysis of Intracerebral Hematoma

Abstract

Background and Purpose-We review preliminary experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomographic (CT) guided thrombolysis and aspiration and assess procedure feasibility and safety. Methods-Twelve patients with supratentorial ICH Ն25 mL without suspected underlying structural etiology or coagulopathy and an initial Glasgow Coma Scale (GCS) score of Ն5 were treated. A catheter was directed stereotactically or manually into the ICH through a burr hole under CT guidance. Hematoma aspiration was followed by instillation of urokinase (5 000 to 10 000 IU). This was repeated every 6 to 8 hours at bedside, with interval CT imaging, until the ICH volume diminished to Ͻ25 mL, less than half of its initial volume, or after a maximum of 10 aspirations/instillations. Results-Mean age was 69 years (range 55 to 82 years). Median initial GCS was 12 (range 5 to 14). There were 7 ganglionic and 5 lobar ICH, and baseline hematoma size ranged 29 to 70 mL (mean 46 mL). Final ICH volume ranged from 14 to 51 mL (mean 21 mL), with ICH volume reduction by an average of 57% (range 38% to 70%). One patient (8.3%) suffered hematoma expansion during the procedure. At 6 months after the procedure, 3 patients (25%) had achieved a good recovery (Glasgow Outcome Scale [GOS] score of 5), 5 patients (42%) were dependent (GOS 3), and 1 (8.3%) remained vegetative (GOS 2). Three patients (25%) died in hospital (1 from cardiac arrhythmia and 2 from respiratory failure). Conclusions-CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, disability outcome, time until convalescence, and cost of care in treated and untreated patients.

The ICH Score

“…[13][14][15][16]28 A number of these models have been demonstrated as highly accurate in predicting long-term outcome, and this finding has led to the use of GCS score and ICH hematoma volume as enrollment criteria for various studies of intervention in ICH. 7,8,29 However, several of these models use complex algebraic equations in outcome prediction, and none have been simplified into a standard clinical grading scale analogous to the GCS, NIHSS, Hunt-Hess, WFNS, or Spetzler-Martin scales. It is likely that this lack of a uniform ICH scale has contributed to variability in enrollment criteria for ICH studies as well as to heterogeneity in clinical ICH care.…”

Spontaneous intracerebral hemorrhage: a review

“…The authors of several case series have reported encouraging results when using stereotactic aspiration with fibrinoly-sis. 77,87,88,93,110 Doi, et al, 32 from Japan were the first to use stereotactic aspiration with a hematoma lysis method. Successful use of both urokinase and recombinant tPA has been reported.…”

The Use of a Hydrogel Matrix as a Cellular Delivery Vehicle in Future Cell-Based Therapies: Biological and Non-Biological Considerations

“…Importantly, HyStem-HP's use is congruent with current stroke therapy procedures since it can be administered via a catheter or cannula through a burr hole using computed tomographic (CT) guidance (Montes, et al, 2000).…”