AUTHOR=Volbers Bastian , Niesen Wolf-Dirk , Amiri-Soltani Samuel , Staykov Dimitre , Shah Mukesch Johannes , Lang Stefan , Lücking Hannes , Kuramatsu Joji B. , Huttner Hagen B. , Schwab Stefan , Bardutzky Jürgen 

TITLE=Bedside Catheter Hematoma Evacuation in Vitamin K Antagonist-Related Intracerebral Hemorrhage: A Safe and Feasible Approach

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00807

DOI=10.3389/fneur.2020.00807

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> Although outcome in intracerebral hemorrhage (ICH) patients is generally not improved by surgical intervention, the use of minimally invasive surgery (MIS) has shown promising results. However, vitamin K antagonist (VKA)-related ICH patients are underrepresented in surgical treatment trials. We therefore assessed the safety and efficacy of a bedside MIS approach including local application of urokinase in VKA-related ICH.</p><p><bold>Methods:</bold> Patients with a VKA-related ICH &gt; 20 ml who received bedside hematoma evacuation treatment (<italic>n</italic> = 21) at the University Medical Center Freiburg were retrospectively included for analysis and compared to a historical control group (<italic>n</italic> = 35) selected from an institutional database (University Medical Center Erlangen) according to identical inclusion criteria. Propensity score matching was performed to obtain comparable cohorts. The evolution of hematoma and peri-hemorrhagic edema (PHE) volumes, midline shift, and the occurrence of adverse events were analyzed. Furthermore, we assessed the modified Rankin Scale and NIHSS scores recorded at discharge.</p><p><bold>Results:</bold> Propensity score matching resulted in 16 patients per group with well-balanced characteristics. Median ICH volume at admission was 45.7 (IQR: 24.2–56.7) ml in the control group and 48.4 (IQR: 28.7–59.6) ml in the treatment group (<italic>p</italic> = 0.327). ICH volume at day 7 was less pronounced in the treatment group [MIS: 23.2 ml (IQR: 15.8–32.3) vs. control: 43.2 ml (IQR: 27.5–52.4); <italic>p</italic> = 0.013], as was the increase in midline shift up to day 7 [MIS: −3.75 mM (IQR: −4.25 to −2) vs. control: 1 mM (IQR: 0–2); <italic>p</italic> &lt; 0.001]. No group differences were observed in PHE volume on day 7 [MIS: 42.4 ml (IQR: 25.0–72.3) vs. control: 31.0 ml (IQR: 18.8–53.8); <italic>p</italic> = 0.274] or mRS at discharge [MIS: 5 (IQR: 4–5) and 5 (IQR: 4–5); <italic>p</italic> = 0.949]. No hematoma expansion was observed. The catheter had to be replaced in 1 patient (6%).</p><p><bold>Conclusions:</bold> Bedside catheter-based hematoma evacuation followed by local thrombolysis with urokinase appears to be feasible and safe in cases of large VKA-related ICH. Further studies that assess the functional outcome associated with this technique are warranted.</p><p><bold>Clinical Trial Registration:</bold> DRKS00007908 (German Clinical Trial Register; <ext-link ext-link-type="uri" xlink:href="http://www.drks.de" xmlns:xlink="http://www.w3.org/1999/xlink">www.drks.de</ext-link>)</p>