Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection
Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection
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DOI：
10.3171/jns.1999.90.3.0491
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发表时间：
1999-03-01
影响因子：
4.1
通讯作者：
Brott, TG
中科院分区：
文献类型：
--
作者：
Wagner, KR;Xi, GH;Brott, TG
目的。脑出血（ICB）后超前血肿疏散（<4小时）可能会降低质量效应和水肿发展并改善预后。为了检验这一假设，作者在猪中诱导了洛巴尔血肿。作者在重8至10千克的猪中注入2.5英里的血液中的脑脑白质。在治疗组中，将血块用组织纤溶酶原激活剂（[TPA]，0.3 mg）裂解，并在血肿诱导后3.5小时吸出。通过使用计算机辅助的形态计测定冠状切片，在冠状切片上确定脑部和近日血肿的水肿，并通过计算机辅助形态测定法确定脑部和近日血肿的水肿体积，将大脑撤离迅速降低了升高的大脑组织压力从12.2 +/- 1.3 +/- 0.8 mmmmm降低，降低了升高HG。在24小时时，先前的凝块去除显着减少了血肿的体积（0.40 +/- 0.10，而1.26 +/- 0.13 cm（3），p <0.005）和近日骨膜水肿体积（0.28 +/- 0.05，而1.46 +/- 0.24 +/- 0.24 +/- 0.24 +/- 0.24与未蒸发的对照病变相比，CM（3），P <0.005）。此外，与未经处理的对照相比，在大脑中，没有evans蓝色染料的近日围栏白质的蓝色染料染色。用TPA治疗后，血肿快速而容易吸出，从而显着降低质量效应。 TPA纤维蛋白溶解后的血肿抽吸能够去除大部分血肿（> 70％），显着降低了近日血肿的水肿，并阻止了加血管水肿的发展。这些发现在大动物模型的ICH模型中为临床试验提供了支持，其中包括使用纤维蛋白水解剂和超前立体定位引导的凝块吸入治疗ICH。
Object. Ultra-early hematoma evacuation (< 4 hours) after intracerebral hemorrhage (ICB) may reduce mass effect and edema development and improve outcome. To test this hypothesis, the authors induced lobar hematomas in pigs.Methods. The authors infused 2.5 mi of blood into the frontal cerebral white matter in pigs weighing 8 to 10 kg. In the treatment group, clots were lysed with tissue plasminogen activator ([tPA], 0.3 mg) and aspirated at 3.5 hours after hematoma induction. Brains were frozen in situ at 24 hours post-ICH and hematomal and perihematomal edema volumes were determined on coronal sections by using computer-assisted morphometry.Hematoma evacuation rapidly reduced elevated cerebral tissue pressure from 12.2 +/- 1.3 to 2.8 +/- 0.8 mm Hg. At 24 hours, prior clot removal markedly reduced hematoma volumes (0.40 +/- 0.10 compared with 1.26 +/- 0.13 cm(3), p < 0.005) and perihematomal edema volumes (0.28 +/- 0.05 compared with 1.46 +/- 0.24 cm(3), p < 0.005), compared with unevacuated control lesions. Furthermore, no Evans blue dye staining of perihematomal edematous white matter was present in brains in which the hematomas had been evacuated, compared with untreated controls.Conclusions. Hematomas were quickly and easily aspirated after treatment with tPA, resulting in significant reductions in mass effect. Hematoma aspiration after fibrinolysis with tPA enabled removal of the bulk of the hematoma (> 70%), markedly reduced perihematomal edema, and prevented the development of vasogenic edema. These findings in a large-animal model of ICH provide support for clinical trials that include the use of fibrinolytic agents and ultra-early stereotactically guided clot aspiration for treating ICH.