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Emergency Free-Hand Bedside Catheter Evacuation of Large Intracerebral Hematomas Following Thrombolysis for Ischemic Stroke: A Case Series

  • Juergen BardutzkyEmail author
  • Mukesch Shah
  • Johann Lambeck
  • Stephan Meckel
  • Wolf-Dirk Niesen
Original Work
  • 14 Downloads

Abstract

Introduction

Symptomatic intracerebral hemorrhage (sICH) following systemic thrombolysis for ischemic stroke is often devastating, and open surgical evacuation is considered dangerous due to the increased risk of perioperative bleeding, and stereotactic placement of a catheter is too time-consuming. We therefore evaluated the feasibility of a free-hand bedside catheter technique for emergency hematoma evacuation.

Methods

Patients who had a supratentorial sICH after thrombolysis, a hematoma volume > 30 ml, and an ensuing reduction in vigilance were consecutively treated with acute minimally invasive catheter hematoma evacuation. Catheter insertion and trajectory were planned via 3D-reconstructed computed tomography (CT) scan, and free-hand insertion of an external ventricular catheter into the core of the hematoma was performed bedside, followed by careful blood aspiration. Cranial CT was used to verify catheter position and residual hematoma volume. In cases, where the residual volume exceeded 15 ml, urokinase (5000 IE) was administered into the clot every 6 h until the volume decreased to < 15 ml.

Results

In all six patients, catheter aspiration immediately reduced hematoma volume by 77%, from 73 ± 20 ml to 17 ± 16 ml (p = 0.028). In four patients, the hematoma was almost completely removed (< 10 ml) by singular aspiration. In the remaining two patients with a residual hematoma size > 15 ml, consecutive urokinase application resulted in a further reduction to 1 ml and 15 ml, respectively, after 30 h. The median National Institues of Health Stroke Scale/Score after sICH was 19.5 points, rapidly decreasing to 11 after catheter aspiration (p = 0.027), and further improving to 4 at discharge. No procedure-related complications were observed.

Conclusions

Emergency free-hand bedside catheter aspiration is a reasonable option for hematoma evacuation in large thrombolysis-associated sICH when performed by experienced neurosurgeons. Larger studies would help in determining the generalizability of our findings to other centers and assessing their impact on functional outcome.

Keywords

Thrombolysis Intracerebral hematoma Minimally invasive surgery Urokinase 

Notes

Acknowledgements

None.

Author contributions

JB and WDN contributed to preparing and writing of the manuscript, data acquisition. MS contributed to preparing manuscript, preparing and analysis of images. JL contributed to preparing the manuscript, statistics. SM contributed to preparing of the manuscript and images.

Source of support

None.

Conflict of interest

None.

Ethical approval

The study was approved by our local ethics committee (registration number 161/19).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Freiburg Medical SchoolFreiburgGermany
  2. 2.Department of NeurosurgeryUniversity of Freiburg Medical SchoolFreiburgGermany
  3. 3.Department of NeuroradiologyUniversity of Freiburg Medical SchoolFreiburgGermany

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