Continuous Tissue Plasminogen Activator Infusion Using a Minimally Invasive Irrigating Catheter for the Treatment of Intraparenchymal Hemorrhage Within the Basal Ganglia: Case Reports

Abstract

BACKGROUND AND IMPORTANCE: Intraparenchymal hemorrhage (IPH) is a debilitating and highly morbid type of stroke with limited effective treatment modalities. Minimally invasive evacuation with tissue plasminogen activator (rt-PA) has demonstrated promise for mortality/functional improvements with adequate clot volume reduction. In this study, we report 2 cases of continuous rt-PA infusion using a closed circuit, dual lumen catheter, and irrigation system (IRRAflow) for IPH treatment. CLINICAL PRESENTATION: A 55-year-old man was admitted for acute onset left hemiparesis; he was found to have right basal ganglia IPH. He was treated with continuous rt-PA irrigation using the IRRAflow device, at a rate of 30 mL/h for 119 hours, with a total volume reduction of 87.8 mL and post-treatment volume of 1.2 mL. At 3-month follow-up, he exhibited a modified Rankin score of 4 and improved hemiparesis. A 39-year-old woman was admitted for acute onset left facial droop, left hemianopsia, and left hemiparesis; she was diagnosed with a right basal ganglia IPH. She was treated with drainage and continuous rt-PA irrigation at 30 mL/h for 24 hours, with a total hematoma volume reduction of 41 mL and with a final post-treatment volume of 9.1 mL. At 3-month followup, she exhibited a modified Rankin score of 3 with some improvement in left hemiparesis. CONCLUSION: Continuous rt-PA infusion using a minimally invasive catheter with saline irrigation was feasible and resulted in successful volume reduction in 2 patients with IPH. This technique is similar to the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation (MISTIE) approach but offers the potential advantages of less breaks in the sterile circuit, continuous intracranial pressure monitoring, and may provide more efficient clot lysis compared with intermittent bolusing.

A Case of Craniocervical Junction Arteriovenous Fistulas with a Brainstem Mass Lesion on Imaging: Case Report and Literature Review

“…Routine CT and MRI examinations can be performed to detect occupancy at the site of the lesion. The clinical symptoms and imaging results of occupancy effects may not show any signs of a cerebral hemorrhage, such as loss of consciousness, hemiparesis, and severe headaches in patients [7,8,17], thus increasing the chances of misdiagnosing the disease as a brain tumor. Our patient had an acute onset and a short duration of illness, which indicated a clinical manifestation that was different from a tumor.…”

“…There were prominent vascular markings anterior and posterior to the brain stem on MRI (high signal with contrast and voids on T2 images), which pointed to the possibility of AVF. We ruled out the possibility of an intracranial hemorrhagic lesion, which is often associated with increased intracranial pressure, severe headache, or loss of consciousness [6][7][8]. To further clarify the diagnosis, we performed a digital subtraction angiography We ruled out the possibility of an intracranial hemorrhagic lesion, which is often associated with increased intracranial pressure, severe headache, or loss of consciousness [6][7][8].…”

Continuous Intrathecal Medication Delivery With the IRRAflow Catheter: Pearls and Early Experience

“…Previous studies have reported excellent results with the IR-RAflow in a variety of conditions. [3][4][5][6][7] No reports have yet been published that guide the technical utilization of the IRRAflow, including delivering IT medications.…”