TY - JOUR
T1 - Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage
T2 - Edema reduction and blood-brain barrier protection
AU - Wagner, Kenneth R.
AU - Xi, Guohua
AU - Hua, Ya
AU - Zuccarello, Mario
AU - De Courten-Myers, Gabrielle M.
AU - Broderick, Joseph P.
AU - Brott, Thomas G.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1999/3
Y1 - 1999/3
N2 - Object. Ultra-early hematoma evacuation (< 4 hours) after intracerebral hemorrhage (ICH) may reduce mass effect and edema development and improve outcome. To test this hypothesis, the authors induced lobar hematomas in pigs. Methods. The authors infused 2.5 ml of blood into the frontal cerebral white matter in pigs weighing 8 to 10 kg. In the treatment group, clots were lysed with tissue plasminogen activator ([tPA], 0,3 mg) and aspirated at 3.5 hours after hematoma induction. Brains were frozen in situ at 24 hours post- ICH and hematomal and perihematomal edema volumes were determined on coronal sections by using computer-assisted morphometry. Hematoma evacuation rapidly reduced elevated cerebral tissue pressure from 12.2 ± 1.3 to 2.8 ± 0.8 mm Hg. At 24 hours, prior clot removal markedly reduced hematoma volumes (0.40 ± 0.10 compared with 1.26 ± 0.13 cm3, p < 0.005) and perihematomal edema volumes (0.28 ± 0.05 compared with 1.46 ± 0.24 cm3, p < 0.005), compared with unevacuated control lesions. Furthermore, no Evans blue dye staining of perihematomal edematous white matter was present in brains in which the hematomas had been evacuated, compared with untreated controls. Conclusions. Hematomas were quickly and easily aspirated after treatment with tPA, resulting in significant reductions in mass effect. Hematoma aspiration after fibrinolysis with tPA enabled removal of the bulk of the hematoma (> 70%), markedly reduced perihematomal edema, and prevented the development of vasogenic edema. These findings in a large-animal model of ICH provide support for clinical trials that include the use of fibrinolytic agents and ultra-early stereotactically guided clot aspiration for treating ICH.
AB - Object. Ultra-early hematoma evacuation (< 4 hours) after intracerebral hemorrhage (ICH) may reduce mass effect and edema development and improve outcome. To test this hypothesis, the authors induced lobar hematomas in pigs. Methods. The authors infused 2.5 ml of blood into the frontal cerebral white matter in pigs weighing 8 to 10 kg. In the treatment group, clots were lysed with tissue plasminogen activator ([tPA], 0,3 mg) and aspirated at 3.5 hours after hematoma induction. Brains were frozen in situ at 24 hours post- ICH and hematomal and perihematomal edema volumes were determined on coronal sections by using computer-assisted morphometry. Hematoma evacuation rapidly reduced elevated cerebral tissue pressure from 12.2 ± 1.3 to 2.8 ± 0.8 mm Hg. At 24 hours, prior clot removal markedly reduced hematoma volumes (0.40 ± 0.10 compared with 1.26 ± 0.13 cm3, p < 0.005) and perihematomal edema volumes (0.28 ± 0.05 compared with 1.46 ± 0.24 cm3, p < 0.005), compared with unevacuated control lesions. Furthermore, no Evans blue dye staining of perihematomal edematous white matter was present in brains in which the hematomas had been evacuated, compared with untreated controls. Conclusions. Hematomas were quickly and easily aspirated after treatment with tPA, resulting in significant reductions in mass effect. Hematoma aspiration after fibrinolysis with tPA enabled removal of the bulk of the hematoma (> 70%), markedly reduced perihematomal edema, and prevented the development of vasogenic edema. These findings in a large-animal model of ICH provide support for clinical trials that include the use of fibrinolytic agents and ultra-early stereotactically guided clot aspiration for treating ICH.
KW - Blood-brain barrier
KW - Cerebral hemorrhage
KW - Edema
KW - Fibrinolysis
KW - Pig
KW - White matter
UR - http://www.scopus.com/inward/record.url?scp=0033042014&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033042014&partnerID=8YFLogxK
U2 - 10.3171/jns.1999.90.3.0491
DO - 10.3171/jns.1999.90.3.0491
M3 - Article
C2 - 10067918
AN - SCOPUS:0033042014
SN - 0022-3085
VL - 90
SP - 491
EP - 498
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 3
ER -