Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema.
Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema.
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DOI：
10.1161/strokeaha.111.000411
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发表时间：
2013-03
期刊：
影响因子：
8.3
通讯作者：
MISTIE Investigators
中科院分区：
文献类型：
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作者：
Mould WA;Carhuapoma JR;Muschelli J;Lane K;Morgan TC;McBee NA;Bistran-Hall AJ;Ullman NL;Vespa P;Martin NA;Awad I;Zuccarello M;Hanley DF;MISTIE Investigators
血肿周围水肿 (PHE) 会使 ICH 后的预后恶化。报告表明血液降解产物会导致 PHE。我们假设血肿清除会减少 PHE 体积，而 rt-PA 治疗不会加剧 PHE 体积。 MISTIE II 测试了 ICH 后血肿清除的安全性和有效性。我们对 CT 进行了半自动、计算机化体积分析，以评估血肿清除对 PHE 的影响以及 2) rt-PA 对 PHE 的影响。对基线稳定性 (BLS) 和治疗结束 (EOT) 扫描进行体积分析。对来自 MISTIE II 的 79 名外科患者和 39 名内科患者进行了分析。 EOT 时的平均血肿量，手术组为 19.6±14.5 cc，内科组为 40.7±13.9 cc (p<0.001)。手术组在 EOT 时的水肿量较低：27.7±13.3 cc，低于医疗组：41.7±14.6 cc (p<0.001)。当分析 ICH 去除率 >65%、20-65% 和 <20% 的患者时，观察到血块去除对 PHE 的分级影响 (p<0.001)。 PHE 减少与 ICH 去除百分比之间存在正相关性 (ρ=0.658；p<0.001)。在手术队列中，69 名患者接受了手术抽吸和 rt-PA (S+rt-PA)，而 10 名患者仅接受了手术抽吸 (SO)。两个队列均实现了相似的血栓减少：S+rt-PA，18.9±14.5 cc； SO，24.5±14.0 cc (p=0.26)。 S+rt-PA 中 EOT 时的水肿为 28.1±13.8 cc，SO 中为 24.4±8.6 cc (p=0.41)。血肿清除与 PHE 的显着减少相关。此外，rt-PA 似乎不会加剧 PHE，因此当药物输送到颅内血块时，不太可能出现这种神经毒性作用。网址：http://clinicaltrials.gov/ct2/show/NCT00224770?term=MISTIE&rank=1 ClinicalTrials.gov ID：NCT00224770
Perihematomal edema (PHE) can worsen outcomes following ICH. Reports suggest that blood degradation products lead to PHE. We hypothesized that hematoma evacuation will reduce PHE volume and that treatment with rt-PA will not exacerbate it. MISTIE II tested safety and efficacy of hematoma evacuation after ICH. We conducted a semi-automated, computerized volumetric analysis on CT to assess impact of hematoma removal on PHE and 2) effects of rt-PA on PHE. Volumetric analyses were performed on Baseline Stability (BLS) and End of Treatment (EOT) scans. Seventy-nine surgical and 39 medical patients from MISTIE II were analyzed. Mean hematoma volume at EOT was 19.6±14.5 cc for the surgical cohort and 40.7±13.9 cc for the medical cohort (p<0.001). Edema volume at EOT was lower for the surgical cohort: 27.7±13.3 cc than medical cohort: 41.7±14.6 cc (p<0.001). Graded effect of clot removal on PHE was observed when patients with >65%, 20-65%, and <20% ICH removed were analyzed (p<0.001). Positive correlation between PHE reduction and percent of ICH removed was identified (ρ=0.658; p<0.001). In the surgical cohort, 69 patients underwent surgical aspiration and rt-PA (S+rt-PA) while 10 underwent surgical aspiration only (SO). Both cohorts achieved similar clot reduction: S+rt-PA, 18.9±14.5 cc; and SO, 24.5±14.0 cc (p=0.26). Edema at EOT in S+rt-PA was 28.1±13.8 cc and 24.4±8.6 cc in SO (p=0.41). Hematoma evacuation is associated with significant reduction in PHE. Furthermore, PHE does not appear to be exacerbated by rt-PA, making such neurotoxic effects unlikely when the drug is delivered to intracranial clot. URL: http://clinicaltrials.gov/ct2/show/NCT00224770?term=MISTIE&rank=1 Clinicaltrials.gov ID: NCT00224770