gms | German Medical Science

Objective: During the lysis of spontaneous intracerebral hematomas (ICH) applying rtPA a catheter position into the core of the hematoma with a trajectory through the biggest diameter of the clot was assumed to be crucial for an effective and fast clot lysis. Sometimes an entry position of the catheter through cosmetic sensitive or even eloquent regions is needed to achieve such a central catheter position. The aim of this study was to investigate the influence of the catheter position into the hematomas core along the biggest diameter of the hematoma on the lysis process and if this position indeed allows more effective and faster hematoma lysis.

Method: The relative volume reduction within two weeks was estimated in 62 patients with spontaneous ICH, undergoing fibrinolytic therapy with rtPA via an intrahematomal catheter. Two patients (3%) had a rebleeding and were excluded from the analysis. 9 patients were excluded due to CT scans available only later than two weeks after the bleeding. We analyzed a total of 51 patients. The intrahematomal catheter placement was performed using the navigated stylet or pointer guided frameless stereotaxy. The catheter's position was evaluated using a relative error calculating the distance perpendicular to the centre of the catheter in relation to the hematomas diameter. The correlation of the volume reduction with the intrahematomal catheter position was evaluated. We've also performed qualitative analysis of the site of the lysis process within the hematoma.

Results: The mean hematoma volume was 46.9 ml (range 10.51-143.4ml). 26 hematomas were deep-seated. 25 patients (25/51) had a good catheter position along the greatest diameter of the hematoma. A volume reduction >70% within two weeks after the onset of the bleeding was achieved in 32 patients (63%). We found no correlation between a central catheter position and a more effective volume reduction of the hematoma (linear regression; p=0.14). The qualitative analysis has shown a faster hematoma lysis in the direct vicinity to the openings of the catheter. We found a more symmetrical hematoma volume reduction in case of central catheter position into the hematoma.

Conclusions: On the basis of these results the central catheter position along the greatest diameter of the hematoma does not play a significant role for the effectiveness of volume reduction due to rtPA lysis of spontaneous intracerebral hematomas. Direct contact of the hematoma to the catheters openings has to be warranted.