Abstract WP307: Administration of Tissue Plasminogen Activator to Patients with Spontaneous ICH Does Not Lead to an Increase in Perihematomal Edema
INTRODUCTION: In patients with spontaneous intracerebral hemorrhage (ICH), blood toxicity leading to perihematomal edema (PHE) is a major concern. Some observations suggest the possibility that administering tissue plasminogen activator (tPA) increases neurotoxicity and therefore PHE. With reports linking PHE to clinical deterioration and death in hemorrhagic stroke patients, it is important to further investigate any relation between PHE and tPA. We hypothesized that treatment with tPA would show increased levels of edema when compared to surgical aspiration alone.
Methods: Minimally Invasive Surgery plus Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) is a multi-center, prospective, randomized trial testing the safety and efficacy of hematoma evacuation after spontaneous ICH compared to medical management. Study interventions were consistently applied in a protocol-based manner across all study sites. We conducted a semi-automated, computerized volumetric analysis on CT imaging to assess the effect of tPA toxicity on PHE. CT scans were assessed for ICH and PHE volumes at two time points: T1, pre-enrollment, and T2, end of treatment.
Results: Out of 123 patients enrolled, 79 patients in the surgical arm were treated in two respects, 69 received surgical aspiration followed by administration of tPA (S+tPA), and 10 received surgical aspiration only (SO). There was no significant difference between the treatment groups in enrollment GCS, intraventricular involvement, time from symptom onset to T1 or T2, baseline ICH volume, or baseline PHE volume. A slight age difference was seen between the two groups: SO, 68.90±9.2; and S+tPA, 59.43±11.4 (p-value=0.01). Both treatment cohorts achieved similar blood clot reduction: S+tPA, 18.94±14.5 cc; and SO, 24.51±14.0 cc (p-value= 0.26). The mean amount of edema at T2 in patients treated with S+tPA was 28.15±13.8 cc while patients treated with SO was 24.38 ±8.6 cc, showing no exacerbation of edema in either group (p-value=0.41).
Conclusion: These findings demonstrate perihematomal edema is not altered by tPA, making neurotoxicity of tPA unlikely when the drug is delivered to intracranial clot.
- © 2012 by American Heart Association, Inc.