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Catheter placement for lysis of spontaneous intracerebral hematomas: does a catheter position in the core of the hematoma allow more effective and faster hematoma lysis?

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Abstract

For the fibrinolytic therapy of intracerebral hematomas (ICH) using recombinant tissue plasminogen activator (rtPA), a catheter position in the core of the hematoma along the largest clot diameter was assumed to be optimal for an effective clot lysis. However, it never had been proven that core position indeed enhances clot lysis if compared with less optimal catheter positions. In this study, the impact of the catheter position on the effectiveness and on the time course of clot lysis was evaluated. We analyzed the catheter position using a relative error calculating the distance perpendicular to the catheter’s center in relation to hematoma’s diameter and evaluated the relative hematoma volume reduction (RVR). The correlation of the RVR with the catheter position was evaluated. Additionally, we tried to identify patterns of clot lysis with different catheter positions. The patient’s outcome at discharge was evaluated using the Glasgow outcome score. A total of 105 patients were included in the study. The mean hematoma volume was 56 ml. The overall RVR was 62.7 %. In 69 patients, a catheter position in the core of the clot was achieved. We found no significant correlation between catheter position and hematoma RVR (linear regression, p = 0.14). Core catheter position leads to more symmetrical hematoma RVR. Faster clot lysis happens in the vicinity of the catheter openings. We found no significant difference in the patient’s outcome dependent on the catheter position (linear regression, p = 0.90). The catheter position in the core of the hematoma along its largest diameter does not significantly influence the effectiveness of clot lysis after rtPA application.

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Authors and Affiliations

  1. Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany

    Vesna Malinova, Anna Schlegel, Veit Rohde & Dorothee Mielke

Authors
  1. Vesna Malinova
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  2. Anna Schlegel
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  3. Veit Rohde
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  4. Dorothee Mielke
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Corresponding author

Correspondence to Vesna Malinova.

Ethics declarations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [15].

Disclosure of potential conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Local Ethics Committee of the Georg-August-University Göttingen (DOR_93_2014, approved on 17.11.2014).

Informed consent

As the described procedure is an established standard emergency operation at our institution, written informed consent was only obtained, if the patient was awake and conscious. Otherwise, an emergency operation was planned according to the declared intention of the patient or their relatives. An informed consent was not required by the Local Ethics Committee of the Georg-August-University Göttingen for this retrospective analysis of the anonymised patient data.

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Malinova, V., Schlegel, A., Rohde, V. et al. Catheter placement for lysis of spontaneous intracerebral hematomas: does a catheter position in the core of the hematoma allow more effective and faster hematoma lysis?. Neurosurg Rev 40, 397–402 (2017). https://doi.org/10.1007/s10143-016-0792-x

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  • DOI: https://doi.org/10.1007/s10143-016-0792-x

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