(Stroke. 2000;31:834.)
© 2000 American Heart Association, Inc.
Original Contributions |
Stereotactic Computed Tomographic–Guided Aspiration and Thrombolysis of Intracerebral Hematoma
Protocol and Preliminary Experience
From the Neurovascular Surgery Program, Department of Neurosurgery (J.M.M., J.H.W., I.A.A.), and the Stroke Program, Department of Neurology (P.B.F.), Yale University School of Medicine, New Haven, Conn.
Correspondence to Issam A. Awad, MD, Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, TMP 405, New Haven, CT 06520. E-mail issam.awad{at}yale.edu
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.
Key Words: intracerebral hemorrhage • stereotactic aspiration • stroke, acute • surgical treatment • thrombolysis • urokinase
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