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Medicina (Kaunas). 2017 Dec;53(5):303-309. doi: 10.1016/j.medici.2017.07.006. Epub 2017 Aug 3.

Safety and efficacy of stereotactic aspiration with fibrinolysis for deep-seated spontaneous intracerebral hemorrhages: A single-center experience.

Author information

1
Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
2
Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: k.simaitis@yahoo.com.

Abstract

OBJECTIVE:

The aim of this study was to evaluate feasibility and safety of stereotactic aspiration with fibrinolysis of deep-seated intracerebral hemorrhages (ICH).

MATERIALS AND METHODS:

From March 1995 until December 2016, 58 adult patients (34 men and 24 women; mean age of 56.8±11.8 years) presenting with deep-seated spontaneous supratentorial ICH were treated using a minimally invasive technique. Intracerebral hematomas were aspirated until obvious resistance to free-hand suction and subsequent clot fibrinolysis was done using either streptokinase or recombinant tissue-type plasminogen activator. CT scans were performed at intervals ranging from 24 to 72h. At discharge, functional outcomes were evaluated using the Glasgow outcome scale (GOS). The 30-day mortality rate was evaluated in all patients.

RESULTS:

The average ICH volume on initial CT scan was 34.7±11.1cm3 (range, 20-90cm3). Mean residual hematoma volume after the treatment was 8.0±5.1cm3 (range, 3-32cm3). There was statistically significant reduction of ICH volume after the treatment (P<0.001). Median ICH reduction rate was 5cm3/d (range, 1.5-16.0cm3/d) and 17.2%/d (range, 5.27-40.0%/d). Median discharge GOS score was 3 (range, 1-4). Six (10.9%) patients died during the 30-day follow-up period. Treatment related complications were observed in three (5.5%) patients. In two patients asymptomatic increase of ICH volume occurred and one patient was diagnosed with CNS infection.

CONCLUSIONS:

Stereotactic clot aspiration with subsequent fibrinolytic therapy is safe and feasible treatment procedure associated with significant hematoma resolution rates and acceptable patient outcomes.

KEYWORDS:

Clot aspiration; Fibrinolysis; Intracerebral hemorrhage; Minimally invasive treatment

PMID:
28838850
DOI:
10.1016/j.medici.2017.07.006
[Indexed for MEDLINE]
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