Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: Protocol and preliminary experience

Jose M. Montes, John H. Wong, Pierre B. Fayad, Issam A. Awad

Research output: Contribution to journalArticle

109 Citations (Scopus)

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 ≥25 mL without suspected underlying structural etiology or coagulopathy and an initial Glasgow Coma Scale (GCS) score of ≥5 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 <25 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.

Original languageEnglish (US)
Pages (from-to)834-840
Number of pages7
JournalStroke
Volume31
Issue number4
DOIs
StatePublished - Apr 2000

Fingerprint

Hematoma
Glasgow Outcome Scale
Glasgow Coma Scale
Urokinase-Type Plasminogen Activator
Respiratory Insufficiency
Cardiac Arrhythmias
Catheters
Safety
Costs and Cost Analysis
Mortality

Keywords

  • Intracerebral hemorrhage
  • Stereotactic aspiration
  • Stroke, acute
  • Surgical treatment
  • Thrombolysis
  • Urokinase

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma : Protocol and preliminary experience. / Montes, Jose M.; Wong, John H.; Fayad, Pierre B.; Awad, Issam A.

In: Stroke, Vol. 31, No. 4, 04.2000, p. 834-840.

Research output: Contribution to journalArticle

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