Abstract
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 ≥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 ≤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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 237-245 |
| Number of pages | 9 |
| Journal | Neurocritical Care |
| Volume | 3 |
| Issue number | 3 |
| DOIs | |
| State | Published - Dec 2005 |
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Keywords
- Clot aspiration
- Intracerebral hemorrhage
- Intraventricular hemorrhage
- Minimally invasive surgery
- rtPA
- Thrombolysis
ASJC Scopus subject areas
- Clinical Neurology
- Critical Care and Intensive Care Medicine
Cite this
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, Juan.
In: Neurocritical Care, Vol. 3, No. 3, 12.2005, p. 237-245.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage
AU - Barrett, Ryan J.
AU - Hussain, Rahat
AU - Coplin, William M.
AU - Berry, Samera
AU - Keyl, Penelope M.
AU - Hanley, Daniel F
AU - Johnson, Robert R.
AU - Carhuapoma, Juan
PY - 2005/12
Y1 - 2005/12
N2 - 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 ≥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 ≤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.
AB - 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 ≥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 ≤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.
KW - Clot aspiration
KW - Intracerebral hemorrhage
KW - Intraventricular hemorrhage
KW - Minimally invasive surgery
KW - rtPA
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=29344448271&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=29344448271&partnerID=8YFLogxK
U2 - 10.1385/NCC:3:3:237
DO - 10.1385/NCC:3:3:237
M3 - Article
C2 - 16377836
AN - SCOPUS:29344448271
VL - 3
SP - 237
EP - 245
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
IS - 3
ER -