Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage
Frameless stereotactic aspiration and thrombolysis of spontaneous intracerebral hemorrhage
复制标题
DOI：
10.1385/ncc:3:3:237
复制
发表时间：
2005-01-01
影响因子：
3.5
通讯作者：
Carhuapoma, JR
中科院分区：
文献类型：
--
作者：
Barrett, RJ;Hussain, R;Carhuapoma, JR
前言：为了验证微创技术的可行性和安全性，我们报告了应用无框架立体定向血栓抽吸溶栓治疗自发性脑出血(ICH)患者的经验及其对患者30天存活率的影响。我们通过先前验证的方法，将观察到的队列死亡率与其预测的30天脑出血死亡率进行比较。方法：选择标准是诊断为高血压脑出血和脑出血=35cc，意识水平降低，没有脑干压迫。采用无框架立体定向穿刺术/凝块抽吸术，然后行腔内置管。给予重组组织型纤溶酶原激活剂(RtPA)2 mg，每12小时1次，直至脑出血体积10cc，或导管开窗与血栓不再连续。结果：15例患者得到治疗，平均年龄60.7岁。出血部位包括基底节(13例)、丘脑(1例)和脑叶(1例)；平均收缩压；入院时脑出血体积分别为229.3毫米汞柱和59.1cc。发病至血栓抽吸/溶栓的中位时间为1天(0~3天)。平均血肿体积减少到治疗前的17%。并发症有脑室炎(6.6%)和血栓增大(13.3%)。两名患者在30天内死亡。入院时格拉斯哥昏迷评分中位数为10.5(4~15)，出院时为11.0(3~15)。用最保守的估计进行分析，在15例死亡概率为0.33的患者中观察到两例或更少死亡的概率为p=0.079。结论：在这组选定的脑出血患者中，立体定向抽吸和溶栓治疗似乎是可行的，并有改善30d生存率的趋势，将他们预测的死亡数据作为“历史对照”。并发症没有超过预期的发生率。基于本文提供的经验和以前的类似报告，需要进行一项更大规模的随机研究，解决剂量递增、患者选择和最佳治疗窗口问题。
Introduction: To test the feasibility and safety of a minimally invasive technique, we report our experience in treating spontaneous intracerebral hemorrhage (ICH) patients by using frameless stereotactic clot aspiration-thrombolysis and its effects on their 30-day survival. We compared the observed cohort mortality with its predicted 30-day ICH mortality, by using previously validated methods.Methods: Selection criteria were diagnosis of hypertensive ICH >= 35 cc, reduced level of consciousness, and no brainstem compression. Frameless stereotactic puncture/clot aspiration followed by intraclot external catheter placement was performed. Two milligrams of recombinant tissue plasminogen activator (rtPA) was administered q12 hours until ICH volume! 10 cc, or the catheter fenestrations were no longer in continuity with the clot.Results: Fifteen patients were treated, mean age was 60.7 years. Hemorrhage locations included basal ganglia (13), thalamic (1), and lobar (1); mean systolic blood pressure; and admission ICH volumes were 229.3 mmHg and 59.1 cc, respectively. Median time from ictus to clot aspiration/thrombolysis was 1 (range 0-3) day. Mean hematoma volume was reduced to 17% of pretreatment size. Complications were ventriculitis (6.6%) and clot enlargement (13.3%). Two patients were dead at 30 days. Median Glasgow Coma Scale (GCS) scores were 10.5 (4-15) at admission and 11.0 (3-15) at discharge. By using the most conservative estimate for analysis, probability of observing two or fewer deaths among 15 patients with an overall probability of dying calculated at 0.33 was p = 0.079.Conclusions: In this selected cohort of patients with ICH, stereotactic aspiration and thrombolytic washout seemed to be feasible and to have a trend towards improved 30-day survival, when using their predicted mortality data as "historical control." Complications did not exceed expected incidence rates. Based on the experience presented here as well as previous similar reports, a larger, randomized study addressing dose escalation, patient selection, and best therapeutic window is needed.