gms | German Medical Science

Objective: Since Desmoteplase (DSPA) differs from recombinant tissue plasminogen activator (rtPA) in its higher fibrinogen affinity and absence of excitotoxicity, we regarded it as a key candidate for local fibrinolysis of experimental intracerebral hemorrhages.

Methods: In 17 pigs with a body weight of 30-35 kg, a balloon was inflated in the right frontal white matter to create a preformed cavity. Subsequently, autologous venous blood was injected ICP-controlled via a 1.2 cm-long catheter attached to a subgaleal Rickham reservoir. After MR imaging, DSPA (n=7) or rtPA (n=4) were injected in equimolar concentrations into the hematoma immediately after hematoma induction. In 6 control pigs, the hematoma was not treated at all. For hematoma and edema quantitation, MR imaging was repeated using T2* weighted and FLAIR sequences 4 and 10 days after hematoma induction.

Results: In the 6 DSPA-treated pigs, the hematoma significantly reduced from 1.36±0.45 cm³ to 0.43±0.37 cm³ (p<0.02) and the increase in edema size from 0.92±0.78 cm³ to 1.01±1.7 cm³ within 10 days was not significant as opposed to both the rtPA-treated and control pigs. The inflammatory reactions measured on EvG-stained slices was significantly less in DSPA-treated pigs compared with rtPA-treated pigs.

Conclusions: Local administration of DSPA exerts a minor degree of edema formation and inflammatory reactions in pigs with intracerebral hemorrhages. For its lacking excitotoxic properties, DSPA appears favourable to rtPA in local clot lysis.