Intraclot Recombinant Tissue-type Plasminogen Activator Reduces Perihematomal Edema and Mortality in Patients with Spontaneous Intracerebral Hemorrhage

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 34; no. 2; pp. 165 - 171
• Main Author: 连立飞 许峰 唐洲平 薛峥 梁奇明 胡琦 朱文浩 康慧聪 刘晓艳 王芙蓉 朱遂强
• Format: Journal Article
• Language: English
• Published: Heidelberg Huazhong University of Science and Technology 01.04.2014; Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030,China
• Subjects: Adult; Aged; Brain Edema - drug therapy; Brain Edema - mortality; Brain Edema - pathology; Brain Edema - surgery; Cerebral Hemorrhage - drug therapy; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - pathology; Cerebral Hemorrhage - surgery; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures; rt-PA; Tissue Plasminogen Activator - administration & dosage; Tomography, X-Ray Computed; Treatment Outcome; 患者; 死亡率; 水肿; 组织型纤溶酶原激活剂; 脑出血; 血肿; 重组; intracerebral hemorrhage; recombinant tissue-type plasminogen activator; clot aspiration; minimally invasive surgery; perihematomal edema
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-014-1252-x

The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator （rt-PA） on perihematomal edema （PHE） development in patients with intracerebral hemorrhage （ICH） treated with minimally invasive surgery （MIS） and the effects of intraclot rt-PA on the 30-day survival. We reviewed the medical records of ICH patients undergoing MIS between October 2011 and July 2013. A volumetric analysis was done to assess the change in PHE and ICH volumes at pre-MIS （T1）, post-MIS （T2） and day 10-16 （T3） following diagnostic computed tomographic scans （To）. Forty-three patients aged 52.8±11.1 years with （n=30） or without rt-PA （n=13） were enrolled from our institutional ICH database. The median rt-PA dose was 1.5 （1） mg, with a maximum dose of 4.0 mg. The ratio of clot evacuation was significantly increased by intraclot rt-PA as compared with controls （77.9%±20.4% vs. 64%±15%; P=0.046）. From TI to T2, reduction in PHE volume was strongly associ- ated with the percentage of clot evacuation （p=0.34; P=-0.027）. In addition, PHE volume was positively correlated with residual ICH volume at the same day （p ranging from 0.39-0.56, P〈0.01）. There was no correlation between the cumulative dose of rt-PA and early （T2） PHE volume （p=0.24; P=0.12） or de- layed （T3） PHE volume （p=0.19; P=0.16）. The 30-day mortality was zero in this cohort. In the selected cohort of ICH patients treated with MIS, intraclot rt-PA accelerated clot removal and had no effects on PHE formation. MIS aspiration and low dose of rt-PA seemed to be feasible to reduce the 30-day mor- tality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed.