Ultrasound Therapy Facilitates Hemorrhage Evacuation

A novel therapy, which combines ultrasound and recombinant tissue plasminogen activator (rt-PA) to treat intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH), is both safe and efficient.

Researchers at the Swedish Neuroscience Institute (SNI, Seattle, WA, USA) conducted a study that involved 35 patients who presented with ICH and IVH and who were screened between November 2008 and July 2009 for entry into the study. Entry criteria included the spontaneous onset of ICH of over 25 cc, or IVH producing a ventricular obstruction. In all, nine patients who met the criteria received a ventricular drainage catheter and an ultrasound microcatheter that were stereotactically delivered together directly into the IVH or ICH; rt-PA and 24 hours of continuous sonolysis therapy were then delivered and gravity drainage was performed. In patients with IVH, a total of 3 mg of rt-PA was injected, and in patients with intraparenchymal hemorrhages, a total of 0.9 mg rt-PA was injected, in three doses over the 24-hour period.

The researchers found that all patients had significant volume reductions of the treated hemorrhage; the mean percentage volume reduction after 24 hours of treatment--compared to the pre-treatment stability scans as determined by computerized tomography (CT)--were 59 % for ICH, and 45.1% for IVH. There were no significant intracranial infections or episodes of re-bleeding by clinical or CT assessment. Clinical improvements were demonstrated at 30 days in seven out of nine patients; one of the patient died. The rate of thrombolysis was compared between the eight patients who completed treatment to cohorts of patients in other studies treated using identical doses of tPA and catheter drainage, but without ultrasound; the comparison data showed a faster rate of lysis during the first 24 hours of treatment in the sonolysis patients. During the study, he researchers used the EKOS (Bothell, WA, USA) EkoSonic Endovascular System with Rapid Pulse Modulation. The study was presented at the American Heart Association (AHA) International Stroke Conference, held during March 2010 in San Antonio (TX, USA).

"Lysis and drainage of spontaneous ICH and IVH with reduction of mass effect can be accomplished rapidly and safely by sonothrombolysis using stereotactically delivered drainage and ultrasound catheters through a burr hole,” said lead author David Newell, M.D., coexecutive director of the SNI. "A larger clinical trial with catheters specifically designed for brain blood clot removal is warranted.”

ICH is a devastating form of stroke; half of all patients die within one month of the event, and those who survive typically suffer dramatic loss of brain function and motor skills. Often, they are unable to resume normal activities such as caring for themselves, straining family members, or requiring more extensive, expensive ongoing professional care.

Related Links:
Swedish Neuroscience Institute