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- Title
No exacerbation of perihematomal edema with intraclot urokinase in patients with spontaneous intracerebral hemorrhage.
- Authors
Lian, Lifei; Xu, Feng; Hu, Qi; Liang, Qiming; Zhu, Wenhao; Kang, Huicong; Liu, Xiaoyan; Tang, Zhouping; Zhu, Suiqiang
- Abstract
Background: Perihematomal edema (PHE) can worsen patient outcomes after spontaneous intracerebral hemorrhage (ICH). Minimally invasive surgery (MIS) in combination with thrombolytic removal of hematoma has been proven to be a promising treatment strategy. However, preclinical studies have suggested that intraclot thrombolysis may exacerbate PHE after ICH. Herein, we investigated the effects of MIS and urokinase on PHE. Methods: ICH patients were retrospectively identified from our institutional ICH database. Computerized volumetric analysis was applied to assess changes in both ICH and PHE volumes using computed tomographic (CT) scans of T (pre-MIS) and T (post-MIS) time points. Relative PHE (rPHE) was calculated as a ratio of PHE and T ICH volume. Results: Data from 60 MIS plus urokinase (MIS + U), 20 MIS aspiration only (MO), and 30 control patients were analyzed. The ICH volume, PHE volume and rPHE on T CT in both MIS + U and MO groups significantly decreased as compared with the control group (ICH volume, 13.7 ± 5.7 ml, 17.0 ± 10.5 ml vs. 30.5 ± 10.3 ml, P < 0.01; PHE volume, 36.5 ± 18.9 ml, 32.2 ± 17.5 ml vs. 45.4 ± 16.0 ml, P < 0.01; rPHE, 0.9 ± 0.4, 0.8 ± 0.4 vs.1.4 ± 0.5, P < 0.01). Between the MIS + U and MO groups, the ICH volume, PHE volume and rPHE at T trended towards similarity, but was not significant ( P = 0.09, P = 0.40, P = 0.43). Furthermore, we found a significant correlation between the percent of ICH removal and PHE reduction (r = 0.59, P < 0.01). There was no correlation between the cumulative dose of urokinase and either T PHE volume (r = 0.19; P = 0.16) or T rPHE (r = -0.12; P = 0.37). Conclusions: Hematoma evacuation using MIS leads to a significant reduction in PHE. Furthermore, the use of urokinase does not exacerbate PHE, making its hypothesized proedematous effects unlikely when the thrombolytic is administered directly into the clot.
- Subjects
CEREBRAL hemorrhage; UROKINASE; DISEASE exacerbation; ENDOSCOPIC surgery; EDEMA; THROMBOLYTIC therapy
- Publication
Acta Neurochirurgica, 2014, Vol 156, Issue 9, p1735
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-014-2130-9