Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage

Ryan J. Barrett, Rahat Hussain, William M. Coplin, Samera Berry, Penelope M. Keyl, Daniel F Hanley, Robert R. Johnson, Juan Carhuapoma

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)237-245
Number of pages9
JournalNeurocritical Care
Volume3
Issue number3
DOIs
StatePublished - Dec 2005

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Cerebral Hemorrhage
Patient Selection
Mortality
Hypertensive Intracranial Hemorrhage
Catheters
Blood Pressure
Paracentesis
Glasgow Coma Scale
Survival
Tissue Plasminogen Activator
Basal Ganglia
Consciousness
Hematoma
Brain Stem
Aspirations (Psychology)
Hemorrhage
Safety
Incidence

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 journalArticle

Barrett, Ryan J. ; Hussain, Rahat ; Coplin, William M. ; Berry, Samera ; Keyl, Penelope M. ; Hanley, Daniel F ; Johnson, Robert R. ; Carhuapoma, Juan. / Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage. In: Neurocritical Care. 2005 ; Vol. 3, No. 3. pp. 237-245.
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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

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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.

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