gms | German Medical Science

Objective: Perihematomal diffusion restriction decreases significantly after combined treatment (rtPA+ultrasound), which can be attributed to the highest hematoma volume reduction in this group. No alterations in perfusion, extent of edema or micro hemorrhages were observed. This proves the safety of intracranial sonothrombolysis.

Methods: Experimental ICH was placed in the right frontal lobe in 16 male pigs in intubation narcosis. Animals underwent 4 different treatment modalities (group 1 drainage only n=3; group 2 rtPA n=5; group 3 ultrasound n=4; and group 4 ultrasound+rtPA n=4). Cranial MRI was immediately performed after ICH placement and 2 h after treatment. Changes in perfusion, diffusion, edema and micro hemorrhages were assessed by a blinded neuroradiologist using the Sectra IDS7 19.1.2 software.

Results: No significant differences were seen in the edema volume at the end of the treatment between the 4 groups. Neither hyper- nor hypoperfusion was found. Perihematomal diffusion restriction after treatment was increased in group 1 (12.33±21.36 mm3 before and 14.87±25.75 mm3 after treatment) and group 3 (137.1±110.3 mm3 before and 153.1± 125.8 mm3 after treatment) after treatment and unchanged in group 2 (33.92±83.08 mm3 before and 33.57±82.22 mm3after treatment). Only in group 4 was the diffusion restriction decreased (123.6±123.8 mm3 before and 97.55±102 mm3 after treatment, p=0.0455). This effect might correlate with hematoma volume reduction at the end of the treatment, which has previously been shown to be significantly higher in group 4. In the ipsilateral hemisphere 1 micro hemorrhage each was observed in 1 rtPA treated and in 1 rtPA+ultrasound treated animal.

Conclusion: A small clinical trial has shown the effectiveness of intralesional, catheter based, ultrasound enhanced rtPA-fibrinolysis as a treatment of intracerebral hemorrhage. Previously we found an increased fibrinolysis and hematoma dissolution in experimental ICH (porcine model) using a combination of endosonography and rtPA. Less is known about the effects of endosonography in the perihematomal zone and distant brain tissue. Therefore the aim of this study was a detailed pre- and post-treatment MRI-analysis of these porcine brains after experimental ICH to assess early side effects like edema, perfusion or diffusion alterations or micro hemorrhages.