Intraclot recombinant tissue-type plasminogen activator reduces perihematomal edema and mortality in patients with spontaneous intracerebral hemorrhage.
10.1007/s11596-014-1252-x
- Author:
Li-fei LIAN
1
;
Feng XU
;
Zhou-ping TANG
;
Zheng XUE
;
Qi-ming LIANG
;
Qi HU
;
Wen-hao ZHU
;
Hui-cong KANG
;
Xiao-yan LIU
;
Fu-rong WANG
;
Sui-qiang ZHU
Author Information
1. Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China, lianlifei@gmail.com.
- Publication Type:Journal Article
- MeSH:
Adult;
Aged;
Brain Edema;
drug therapy;
mortality;
pathology;
surgery;
Cerebral Hemorrhage;
drug therapy;
mortality;
pathology;
surgery;
Female;
Humans;
Male;
Middle Aged;
Minimally Invasive Surgical Procedures;
Tissue Plasminogen Activator;
administration & dosage;
Tomography, X-Ray Computed;
Treatment Outcome
- From:
Journal of Huazhong University of Science and Technology (Medical Sciences)
2014;34(2):165-171
- CountryChina
- Language:English
-
Abstract:
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 (T0). 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 T1 to T2, reduction in PHE volume was strongly associated with the percentage of clot evacuation (ρ=0.34; P=0.027). In addition, PHE volume was positively correlated with residual ICH volume at the same day (ρ 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 (ρ=0.24; P=0.12) or delayed (T3) PHE volume (ρ=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 mortality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed.
