No evidence of preoperative hematoma growth representing an increased postoperative rebleeding risk for minimally invasive aspiration and thrombolysis of ICH

Abstract

The minimally invasive aspiration and thrombolysis has emerged as a promising strategy management modifying the neurological outcome of ICH (intracerebral hemorrhage) patients. In the present study, we introduce our experience with minimally invasive aspiration and thrombolysis for ICH and investigate whether the preoperative hematoma growth represents an increased postoperative rebleeding risk. There were 128 ICH patients enrolled in this report. All the ICH patients were diagnosed by the baseline CT scan in the initial 6 hours after ictus. Within the 24 hours after ictus, a second CT scan was performed to estimate whether existed the preoperative hematoma growth. The first aspiration was avoided in the first 6 hours after symptom onset. All the patients were divided into two groups: preoperative hematoma growth group (Group A) and non-preoperative hematoma growth group (Group B). After the hematoma aspiration, subsequent thrombolysis and drainage were performed and CT scans were repeated everyday until the puncture needle and catheter were removed. Forty-nine cases of all the treated patients were demonstrated with preoperative hematoma growth and sixteen cases were identified with postoperative rebleeding. No significant difference was demonstrated in the proportion of single/double needle puncture, hematoma volume of aspiration, drained volume, total dose of urokinase between Group A and B (P = 0.674, 0.212, 0.831 and 0.862, respectively). No significant difference in the incidence of postoperative rebleeding, the mean volume of residual hematoma and GCS score after the aspiration and thrombolysis was detected between the two groups (P = 1.000, 0.894 and 0.969, respectively). As to the mortality in hospital, the significant difference between Group A and B was not identified (P = 0.389). Our date suggests there is no evidence of preoperative hematoma growth representing an increased postoperative rebleeding risk for the minimally invasive aspiration and thrombolysis of spontaneous intracerebral hemorrhage.

Post-operative re-bleeding in patients with hypertensive ICH is closely associated with the CT blend sign

“…Minimally invasive aspiration followed by thrombolysis has emerged as a promising strategy for modifying the neurological outcome of patients with ICH [3, 4, 11]. Post-operative re-haemorrhage remains a great clinical problem.…”

“…The hypodensity in the haematoma, blend sign, and irregularity of the haematoma were found to be closely related to early haematoma growth or enlargement [9, 10]. However, there was no evidence of preoperative haematoma growth, which would represent an increased postoperative re-bleeding risk for the minimally invasive aspiration of spontaneous intracerebral haemorrhage [11]. Previous studies have demonstrated that the computed tomography angiography(CTA)spot sign is associated with more intraoperative bleeding, more postoperative re-haemorrhage, and larger residual ICH volumes in patients undergoing haematoma evacuation for spontaneous ICH [12].…”

Effects of minimally invasive procedures for evacuation of intracerebral hematoma in early stages on MMP-9 and BBB permeability in rabbits

“…Recently published studies have demonstrated that minimally invasive procedures can successfully evacuate intracerebral hematomas and improve the outcome of patients [2,4,5,7-11]. Minimally invasive stereotactic puncture and thrombolysis therapy have emerged as a promising management strategy for ICH patients [4,6]. However, the pathophysiological time window for minimally invasive surgery remains to be elucidated.…”

“…Although the efficacy of surgical treatment of ICH remains unproven and controversial [5], and open surgery does not appear to improve the patient’s outcome, less invasive methods of hematoma evacuation seem to show promising results in improving patient outcome and survival [5]. Minimally invasive stereotactic puncture and thrombolysis therapy have emerged as a promising management strategy for ICH patients [4,6]. Recently published studies have demonstrated that minimally invasive procedures can successfully evacuate intracerebral hematomas and improve the outcome of patients [2,4,5,7-11].…”

Modifying the details of aspiration operation may contribute to the improvement of prognosis of patients with ICH

“…Till the beginning of 2008, more than 400 thousand patients had received this operation according to a report from the 5 th national symposium on aspiration with metal puncture needle of hematoma in mainland of China (11/28/08 to 12/02/08, Kunming, China). In China mainland, a large number of reports had suggested that this treatment way helped to reduce the mortality and complications and to improve the long-term quality of life of survivors (26,27,28). However, more convincing evidences are still needed.…”