PREDICTION OF FUNCTIONAL OUTCOMES IN SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE PATIENTS TREATED WITH STEREOTACTIC COMPUTED TOMOGRAPHIC-GUIDED ASPIRATION AND RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR

Abstract

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.