PREDICTION OF FUNCTIONAL OUTCOMES IN SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE PATIENTS TREATED WITH STEREOTACTIC COMPUTED TOMOGRAPHIC-GUIDED ASPIRATION AND RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR
Nội dung chính của bài viết
Tóm tắt
Objectives: To evaluate factors influencing the outcomes in supratentorial intracerebral hemorrhage (ICH) patients treated with stereotactic computed tomographic (CT) guided aspiration and recombinant tissue plasminogen activator (rt-PA). Methods: A prospective study on 80 spontaneous supratentorial ICH cases from February 2017 to June 2020, analyzing the 12-month outcomes and identifying clinical and radiological factors for poor prognosis within 12 months. Results: The mean age was 55.6 years (SD 11.4). The median pre-operation GCS score was 9 (IQR 6 - 12). The mean final ICH volume was 23.9mL (SD 24.6), with ICH volume reduction by an average of 66%. 12 months after the procedure, 40 patients (50%) had poor outcomes (mRS score 4 - 6). In multivariate analysis, age (OR = 1.058, 95%CI = 1.007 - 1.112; p = 0.026), the GCS score before operation (OR = 0.666, 95%CI = 0.448 - 0.992; p = 0.046), the midline shift before operation (OR = 1.301, 95%CI = 1.057 - 1.601; p = 0.013), and the residual volume hematoma ≥ 20mL (OR = 4.402, 95%CI = 1.393 - 13.913, p = 0.012) were the significant predictors of a poor 12-month outcome. Conclusion: CT-guided thrombolysis and aspiration can be safe and effective in reducing ICH volume. Age, the GCS score before the operation, the midline shift before the operation, and final residual volume hematoma ≥ 20mL were significant predictors of a poor 12-month outcome.
Chi tiết bài viết
Từ khóa
Intracerebral hemorrhage, Stereotactic aspiration, Recombinant tissue plasminogen activator (rt-PA), 12-month outcome, Prognosis
Tài liệu tham khảo
2. Daverat P, et al. Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. 1991; 22(1):1-6.
3. Hanley DF, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): A randomised, controlled, open-label, blinded endpoint phase 3 trial. 2019; 393(10175):1021-1032.
4. Sirh S and HR Park. Optimal Surgical timing of aspiration for spontaneous supratentorial intracerebral hemorrhage. J Cerebrovasc Endovasc Neurosurg. 2018; 20(2):96-105.
5. Choo YS, et al. Borderline basal ganglia hemorrhage volume: Patient selection for good clinical outcome after stereotactic catheter drainage. 2016; 125(5):1242-1248.
6. aBroderick BJ, B TG, and G JC. Intracerebral hemorrhage volume measurement. Stroke. 1994; 25:1524-4628.
7. Greenberg SM, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. 2022; 53(7): e282-e361.
8. Montes JM, et al. Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: Protocol and preliminary experience. 2000; 31(4):834-840.
9. Zhou X, et al. Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: A meta-analysis of randomized controlled trials. 2012; 43(11):2923-2930.
10. Moussa WMM and WJNr Khedr. Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial. 2017; 40:115-127.