Cerebral amyloid angiopathy-related intracerebral hemorrhage: Feasibility and safety of bedside catheter hematoma evacuation with urokinase
•First study that evaluated free hand bedside catheter aspiration in CAA patients.•For up to 4 days urokinase was administered via the catheter.•Hematoma reduction was observed in all patients upon initial aspiration.•Significant hematoma reduction was observed after local clot lysis with urokinase....
Gespeichert in:
| Veröffentlicht in: | Clinical neurology and neurosurgery 2020-03, Vol.190, p.105655-105655, Article 105655 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 105655 |
|---|---|
| container_issue | |
| container_start_page | 105655 |
| container_title | Clinical neurology and neurosurgery |
| container_volume | 190 |
| creator | Bardutzky, Jürgen Hieber, Maren Roelz, Roland Meckel, Stephan Lambeck, Johann Niesen, Wolf-Dirk |
| description | •First study that evaluated free hand bedside catheter aspiration in CAA patients.•For up to 4 days urokinase was administered via the catheter.•Hematoma reduction was observed in all patients upon initial aspiration.•Significant hematoma reduction was observed after local clot lysis with urokinase.•Rebleeding upon administration of urokinase occurred in 1 patient (5 %).
Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage (ICH). However, data on surgical intervention in CAA-related ICH is very limited. In this retrospective study we assessed safety and efficacy of free-hand catheter aspiration followed by local thrombolysis in CAA-related large ICH.
Patients with CAA-related lobar ICH>30 ml that were treated with this catheter technique were identified from our prospective database. The catheter was inserted at the bedside in the core of the hematoma and urokinase (5000IE) was administered every 6 h for a maximum of 4 days. Evolution of hematoma volume, perihemorrhagic edema (PHE) and midline-shift (MLS) as well as adverse events and functional outcome were analyzed.
Twenty-one patients (median age 79 years) were treated between 2013-2018. Hematoma volume decreased from 70 ml at admission (IQR 49–98 ml) to 52 ml (IQR 35−76 ml, p |
| doi_str_mv | 10.1016/j.clineuro.2019.105655 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2333929385</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0303846719304512</els_id><sourcerecordid>2425647424</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-578ef4a6beb07a44a92c869773985d78bfd2cb315698f394f1b3664b26d840693</originalsourceid><addsrcrecordid>eNqFkc1uEzEYRUcIREPhFSpLbNhM8N94bFagqAWkSmzateWfbxqHmXGwPUV5Bl66jtKwYMPKlnXu9WefprkieE0wER93azeGGZYU1xQTVQ870XUvmhWRPW2FEvJls8IMs1Zy0V80b3LeYYwZE_J1c8GIwkQqtmr-bCCBTWZEZjqMMXhk5ocQ96ZsD22C0RTwKMwlGXcGtzDFlLbmAT6hGzA52DCGcqhBj7IZoG7jgCz4HDwgV5ugQDrGTImTQfBo3GJKiDP6HcoW1Tf8DLPJ8LZ5NZgxw7vn9bK5v7m-23xrb398_b75cts6pkRpu17CwI2wYHFvODeKOilU3zMlO99LO3jqLCOdUHJgig_EMiG4pcJLjoVil82HU-8-xV8L5KKnkB2Mo5khLllTxpiiismuou__QXdxSXOdTlNOO8F7TnmlxIlyKeacYND7FCaTDppgfdSld_qsSx916ZOuGrx6rl_sBP5v7OynAp9PANT_eAyQdHYBZgc-JHBF-xj-d8cTlxmsIQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2425647424</pqid></control><display><type>article</type><title>Cerebral amyloid angiopathy-related intracerebral hemorrhage: Feasibility and safety of bedside catheter hematoma evacuation with urokinase</title><source>ScienceDirect Journals (5 years ago - present)</source><source>ProQuest Central UK/Ireland</source><creator>Bardutzky, Jürgen ; Hieber, Maren ; Roelz, Roland ; Meckel, Stephan ; Lambeck, Johann ; Niesen, Wolf-Dirk</creator><creatorcontrib>Bardutzky, Jürgen ; Hieber, Maren ; Roelz, Roland ; Meckel, Stephan ; Lambeck, Johann ; Niesen, Wolf-Dirk</creatorcontrib><description>•First study that evaluated free hand bedside catheter aspiration in CAA patients.•For up to 4 days urokinase was administered via the catheter.•Hematoma reduction was observed in all patients upon initial aspiration.•Significant hematoma reduction was observed after local clot lysis with urokinase.•Rebleeding upon administration of urokinase occurred in 1 patient (5 %).
Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage (ICH). However, data on surgical intervention in CAA-related ICH is very limited. In this retrospective study we assessed safety and efficacy of free-hand catheter aspiration followed by local thrombolysis in CAA-related large ICH.
Patients with CAA-related lobar ICH>30 ml that were treated with this catheter technique were identified from our prospective database. The catheter was inserted at the bedside in the core of the hematoma and urokinase (5000IE) was administered every 6 h for a maximum of 4 days. Evolution of hematoma volume, perihemorrhagic edema (PHE) and midline-shift (MLS) as well as adverse events and functional outcome were analyzed.
Twenty-one patients (median age 79 years) were treated between 2013-2018. Hematoma volume decreased from 70 ml at admission (IQR 49–98 ml) to 52 ml (IQR 35−76 ml, p < 0.001) immediately after catheter aspiration, and to 23.5 ml (IQR 17–47 ml, p < 0.001) at the end of urokinase treatment. At day 4, PHE volume (from 45 ml [IQR 33–71 ml] to 36 ml [IQR 22–50 ml]; p = 0.001) and MLS (from 5 mm [IQR 3.5–7 mm] to 1 mm [IQR 0.5–3 mm]; p < 0.001) were reduced significantly. No infection was observed, rebleeding after administration of 4 × 5000IE urokinase occurred in one patient (5 %). At discharge, modified Rankin Scale was 3 in 33 %, 4 in 24 %, and 5 in 43 % of patients, and had further improved after rehabilitation to an mRS of 2 in 10 %, 3 in 38 %, 4 in 19 %, and 5 in 33 % (median 9 weeks after ictus). There were no patient deaths during this time.
Bedside catheter hematoma evacuation in large CAA-related ICH seemed feasible and safe and could immediately decrease mass effect. Further studies assessing functional outcome are warranted.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2019.105655</identifier><identifier>PMID: 31901893</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Amyloid ; Catheters ; Cerebral amyloid angiopathy ; Edema ; Hematoma ; Hemorrhage ; Intracerebral hemorrhage ; Minimally-Invasive surgery ; Neurology ; Patients ; Rehabilitation ; Stroke ; Thrombolysis ; U-Plasminogen activator ; Urokinase</subject><ispartof>Clinical neurology and neurosurgery, 2020-03, Vol.190, p.105655-105655, Article 105655</ispartof><rights>2019 Elsevier B.V.</rights><rights>Copyright © 2019 Elsevier B.V. All rights reserved.</rights><rights>2019. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-578ef4a6beb07a44a92c869773985d78bfd2cb315698f394f1b3664b26d840693</citedby><cites>FETCH-LOGICAL-c396t-578ef4a6beb07a44a92c869773985d78bfd2cb315698f394f1b3664b26d840693</cites><orcidid>0000-0002-0985-7583</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2425647424?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994,64384,64386,64388,72240</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31901893$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bardutzky, Jürgen</creatorcontrib><creatorcontrib>Hieber, Maren</creatorcontrib><creatorcontrib>Roelz, Roland</creatorcontrib><creatorcontrib>Meckel, Stephan</creatorcontrib><creatorcontrib>Lambeck, Johann</creatorcontrib><creatorcontrib>Niesen, Wolf-Dirk</creatorcontrib><title>Cerebral amyloid angiopathy-related intracerebral hemorrhage: Feasibility and safety of bedside catheter hematoma evacuation with urokinase</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>•First study that evaluated free hand bedside catheter aspiration in CAA patients.•For up to 4 days urokinase was administered via the catheter.•Hematoma reduction was observed in all patients upon initial aspiration.•Significant hematoma reduction was observed after local clot lysis with urokinase.•Rebleeding upon administration of urokinase occurred in 1 patient (5 %).
Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage (ICH). However, data on surgical intervention in CAA-related ICH is very limited. In this retrospective study we assessed safety and efficacy of free-hand catheter aspiration followed by local thrombolysis in CAA-related large ICH.
Patients with CAA-related lobar ICH>30 ml that were treated with this catheter technique were identified from our prospective database. The catheter was inserted at the bedside in the core of the hematoma and urokinase (5000IE) was administered every 6 h for a maximum of 4 days. Evolution of hematoma volume, perihemorrhagic edema (PHE) and midline-shift (MLS) as well as adverse events and functional outcome were analyzed.
Twenty-one patients (median age 79 years) were treated between 2013-2018. Hematoma volume decreased from 70 ml at admission (IQR 49–98 ml) to 52 ml (IQR 35−76 ml, p < 0.001) immediately after catheter aspiration, and to 23.5 ml (IQR 17–47 ml, p < 0.001) at the end of urokinase treatment. At day 4, PHE volume (from 45 ml [IQR 33–71 ml] to 36 ml [IQR 22–50 ml]; p = 0.001) and MLS (from 5 mm [IQR 3.5–7 mm] to 1 mm [IQR 0.5–3 mm]; p < 0.001) were reduced significantly. No infection was observed, rebleeding after administration of 4 × 5000IE urokinase occurred in one patient (5 %). At discharge, modified Rankin Scale was 3 in 33 %, 4 in 24 %, and 5 in 43 % of patients, and had further improved after rehabilitation to an mRS of 2 in 10 %, 3 in 38 %, 4 in 19 %, and 5 in 33 % (median 9 weeks after ictus). There were no patient deaths during this time.
Bedside catheter hematoma evacuation in large CAA-related ICH seemed feasible and safe and could immediately decrease mass effect. Further studies assessing functional outcome are warranted.</description><subject>Amyloid</subject><subject>Catheters</subject><subject>Cerebral amyloid angiopathy</subject><subject>Edema</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Intracerebral hemorrhage</subject><subject>Minimally-Invasive surgery</subject><subject>Neurology</subject><subject>Patients</subject><subject>Rehabilitation</subject><subject>Stroke</subject><subject>Thrombolysis</subject><subject>U-Plasminogen activator</subject><subject>Urokinase</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1uEzEYRUcIREPhFSpLbNhM8N94bFagqAWkSmzateWfbxqHmXGwPUV5Bl66jtKwYMPKlnXu9WefprkieE0wER93azeGGZYU1xQTVQ870XUvmhWRPW2FEvJls8IMs1Zy0V80b3LeYYwZE_J1c8GIwkQqtmr-bCCBTWZEZjqMMXhk5ocQ96ZsD22C0RTwKMwlGXcGtzDFlLbmAT6hGzA52DCGcqhBj7IZoG7jgCz4HDwgV5ugQDrGTImTQfBo3GJKiDP6HcoW1Tf8DLPJ8LZ5NZgxw7vn9bK5v7m-23xrb398_b75cts6pkRpu17CwI2wYHFvODeKOilU3zMlO99LO3jqLCOdUHJgig_EMiG4pcJLjoVil82HU-8-xV8L5KKnkB2Mo5khLllTxpiiismuou__QXdxSXOdTlNOO8F7TnmlxIlyKeacYND7FCaTDppgfdSld_qsSx916ZOuGrx6rl_sBP5v7OynAp9PANT_eAyQdHYBZgc-JHBF-xj-d8cTlxmsIQ</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Bardutzky, Jürgen</creator><creator>Hieber, Maren</creator><creator>Roelz, Roland</creator><creator>Meckel, Stephan</creator><creator>Lambeck, Johann</creator><creator>Niesen, Wolf-Dirk</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0985-7583</orcidid></search><sort><creationdate>202003</creationdate><title>Cerebral amyloid angiopathy-related intracerebral hemorrhage: Feasibility and safety of bedside catheter hematoma evacuation with urokinase</title><author>Bardutzky, Jürgen ; Hieber, Maren ; Roelz, Roland ; Meckel, Stephan ; Lambeck, Johann ; Niesen, Wolf-Dirk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-578ef4a6beb07a44a92c869773985d78bfd2cb315698f394f1b3664b26d840693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Amyloid</topic><topic>Catheters</topic><topic>Cerebral amyloid angiopathy</topic><topic>Edema</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Intracerebral hemorrhage</topic><topic>Minimally-Invasive surgery</topic><topic>Neurology</topic><topic>Patients</topic><topic>Rehabilitation</topic><topic>Stroke</topic><topic>Thrombolysis</topic><topic>U-Plasminogen activator</topic><topic>Urokinase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bardutzky, Jürgen</creatorcontrib><creatorcontrib>Hieber, Maren</creatorcontrib><creatorcontrib>Roelz, Roland</creatorcontrib><creatorcontrib>Meckel, Stephan</creatorcontrib><creatorcontrib>Lambeck, Johann</creatorcontrib><creatorcontrib>Niesen, Wolf-Dirk</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bardutzky, Jürgen</au><au>Hieber, Maren</au><au>Roelz, Roland</au><au>Meckel, Stephan</au><au>Lambeck, Johann</au><au>Niesen, Wolf-Dirk</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebral amyloid angiopathy-related intracerebral hemorrhage: Feasibility and safety of bedside catheter hematoma evacuation with urokinase</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2020-03</date><risdate>2020</risdate><volume>190</volume><spage>105655</spage><epage>105655</epage><pages>105655-105655</pages><artnum>105655</artnum><issn>0303-8467</issn><eissn>1872-6968</eissn><abstract>•First study that evaluated free hand bedside catheter aspiration in CAA patients.•For up to 4 days urokinase was administered via the catheter.•Hematoma reduction was observed in all patients upon initial aspiration.•Significant hematoma reduction was observed after local clot lysis with urokinase.•Rebleeding upon administration of urokinase occurred in 1 patient (5 %).
Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage (ICH). However, data on surgical intervention in CAA-related ICH is very limited. In this retrospective study we assessed safety and efficacy of free-hand catheter aspiration followed by local thrombolysis in CAA-related large ICH.
Patients with CAA-related lobar ICH>30 ml that were treated with this catheter technique were identified from our prospective database. The catheter was inserted at the bedside in the core of the hematoma and urokinase (5000IE) was administered every 6 h for a maximum of 4 days. Evolution of hematoma volume, perihemorrhagic edema (PHE) and midline-shift (MLS) as well as adverse events and functional outcome were analyzed.
Twenty-one patients (median age 79 years) were treated between 2013-2018. Hematoma volume decreased from 70 ml at admission (IQR 49–98 ml) to 52 ml (IQR 35−76 ml, p < 0.001) immediately after catheter aspiration, and to 23.5 ml (IQR 17–47 ml, p < 0.001) at the end of urokinase treatment. At day 4, PHE volume (from 45 ml [IQR 33–71 ml] to 36 ml [IQR 22–50 ml]; p = 0.001) and MLS (from 5 mm [IQR 3.5–7 mm] to 1 mm [IQR 0.5–3 mm]; p < 0.001) were reduced significantly. No infection was observed, rebleeding after administration of 4 × 5000IE urokinase occurred in one patient (5 %). At discharge, modified Rankin Scale was 3 in 33 %, 4 in 24 %, and 5 in 43 % of patients, and had further improved after rehabilitation to an mRS of 2 in 10 %, 3 in 38 %, 4 in 19 %, and 5 in 33 % (median 9 weeks after ictus). There were no patient deaths during this time.
Bedside catheter hematoma evacuation in large CAA-related ICH seemed feasible and safe and could immediately decrease mass effect. Further studies assessing functional outcome are warranted.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>31901893</pmid><doi>10.1016/j.clineuro.2019.105655</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-0985-7583</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0303-8467 |
| ispartof | Clinical neurology and neurosurgery, 2020-03, Vol.190, p.105655-105655, Article 105655 |
| issn | 0303-8467 1872-6968 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2333929385 |
| source | ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Amyloid Catheters Cerebral amyloid angiopathy Edema Hematoma Hemorrhage Intracerebral hemorrhage Minimally-Invasive surgery Neurology Patients Rehabilitation Stroke Thrombolysis U-Plasminogen activator Urokinase |
| title | Cerebral amyloid angiopathy-related intracerebral hemorrhage: Feasibility and safety of bedside catheter hematoma evacuation with urokinase |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-12T02%3A54%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cerebral%20amyloid%20angiopathy-related%20intracerebral%20hemorrhage:%20Feasibility%20and%20safety%20of%20bedside%20catheter%20hematoma%20evacuation%20with%20urokinase&rft.jtitle=Clinical%20neurology%20and%20neurosurgery&rft.au=Bardutzky,%20J%C3%BCrgen&rft.date=2020-03&rft.volume=190&rft.spage=105655&rft.epage=105655&rft.pages=105655-105655&rft.artnum=105655&rft.issn=0303-8467&rft.eissn=1872-6968&rft_id=info:doi/10.1016/j.clineuro.2019.105655&rft_dat=%3Cproquest_cross%3E2425647424%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2425647424&rft_id=info:pmid/31901893&rft_els_id=S0303846719304512&rfr_iscdi=true |