gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Intrahematomal Sonothrombolysis enhances Fibrinolysis in a porcine Model of intracerebral Hemorrhage

Meeting Abstract

  • Julia Masomi-Bornwasser - Mainz, Deutschland
  • Axel Heimann - Mainz, Deutschland
  • Christian Schneider - Mainz, Deutschland
  • Andrea Kronfeld - Mainz, Deutschland
  • Karl-Friedrich Kreitner - Mainz, Deutschland
  • Floian Ringel - Mainz, Deutschland
  • Naureen Keric - Mainz, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.25.03

doi: 10.3205/17dgnc537, urn:nbn:de:0183-17dgnc5375

Published: June 9, 2017

© 2017 Masomi-Bornwasser et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Catheter-based hematoma lysis with recombinant tissue plasminogen activator (rtPA) has emerged to a well-established therapy of spontaneous intracerebral hemorrhage (ICH). A small clinical trial showed effectiveness of intralesional sonothrombolysis in combination with rtPA. Previously we could show a significant increase of rtPA-based fibrinolysis by endosonography in an in vitro model of ICH. The aim of this study was to assess the potential of sonothrombolysis by an endosonography catheter in vivo (porcine ICH-model). We present preliminary results of an ongoing experimental work.

Methods: Deutsche Landrasse male pigs (30–35 kg) were sedated and intubated. Continuous intra-arterial blood pressure was recorded via an arterial femoral line. An intracranial pressure- (ICP) sensor was placed in the left frontal lobe through a twist drill burr hole for monitoring reasons. A right frontal ICH was produced by infusion of 10 ml arterial autologous blood via a continuous infusion (3ml/min). A cranial MRI was performed immediately after ICH placement and 2 h after treatment. The animals were randomized in 4 treatment groups: group 1 (drainage only n=2), group 2 (drainage+rtPA n=3), group 3 (drainage+endosonography, 10 MHz b-mode n=3), and group 4 (drainage+endosonography+rtPA n=3). Liquefied hematoma was drained by a gravity-based system for 1 hour. Hematoma volumes were assessed by segmentation using a neuronavigation planning software (iPlan, Brainlab®). Animals were euthanized 6 h after ictus. Brains were fixed in 4 % PFA, paraffin embedded and sliced for histological analysis. Perihematomal tissue was morphologically analyzed in HE-staining and further characterized by immunohistochemistry.

Results: Hematoma volume reduction in the group 1 was 2.95±3.36%, 40.71±2.758% in group 2, 34.7±6.39% in group 3 and 54.5± 6.91% in group 4. Compared to the control group the groups 2, 3 and 4 showed significant differences in overall hematoma volume reduction (group 1 vs. 2 P=0.0043; group 1 vs. 3 P=0.0139; group 1 vs. 4 P=0.0042). The combination treatment group achieved the greatest hematoma volume reduction and was significant different compared to group 3 (P=0.0132). Mean arterial blood pressure (MAP) and ICP values did not differ between the treatment groups. MAP ranged from 64.9 to 87.4 mmHg and mean preoperative ICP values from 8.1-11.4 mmHg. ICP increased at the time of ICH placement till 91 and decreased again in the following 15 min until 14 mmHg. The HE-staining showed no morphological differences in the perihematomal zone.

Conclusion: The combination of sonography and rtPA seems to be a more effective and safe fibrinolytic therapy compared to rtPA alone, while sonography serves as an accelerator for fibrinolysis. Additionally this endosonography catheter can be applied as a diagnostic imaging tool in b-mode and Doppler mode, which allows realtime intracranial monitoring.