Procedure to Shrink Stroke Blood Clots

An international study has found that a minimally invasive way to treat stroke-related intra-cerebral hematoma, associated with high death rates and severe disability, greatly decreased hospital death rates but showed no advantage six months later.

Hematomas may be treated with clot-busting drugs and drained or removed surgically, but open-brain surgery may further traumatize brain tissue. A minimally invasive procedure could limit tissue damage and require less time. In the study, doctors used imaging equipment to precisely guide a tiny catheter directly into the brain, inject the clot buster urokinase into the clot to liquefy it, and then drain it.

The study involved 71 patients at 13 European centers who had bleeding deep in the upper part of the brain. Of these, 36 were randomized to have the new procedure, while the other 35 had standard drug treatment without surgery. The average patient age was 68 and about 57% were male. All patients had hematoma volume of more than 10 ml. The results showed that the surgical patients averaged an 18 ml reduction in hematoma size seven days after stroke, compared with a 7 ml reduction in patients who received only drug treatment.

"Death in the intervention group decreased from the predicted 88% to 56% in the surgical group and 59% in the nonsurgical group,” said lead investigator Onno Teernstra, M.D., Ph.D., department of neurosurgery, University of Maastricht (The Netherlands; www.unimass.nl). "But no statistically significant difference in mortality and morbidity was found at 180 days.” Dr. Teernstra noted that the reduction in death rate among nonsurgical patients was not anticipated and might be due to the fact that patients in both groups were closely monitored and therefore both benefited from an increase in supportive care.





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