Innovative treatment safe and effective for patients with intracerebral hemorrhage

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A new treatment that treats a subset of stroke patients by mixing minimally invasive surgery, an imaging method compared to “GPS for the brain,” and the clot-busting drug t-PA appears to be effective and safe, according to a multicenter medical trial led by Johns Hopkins researchers.

The novel treatment, detailed initially at this week’s European Stroke Conference in Hamburg, Germany, was developed for patients with intracerebral hemorrhage (ICH), a bleed within the brain that creates a clot to form inside brain tissue. This clot increases pressure and leaches inflammatory chemicals that induce irreversible brain damage, often resulting in fatality or extreme disability. The typical treatments for ICH-either general supportive care including blood pressure control plus ventilation, which is regarded as the current standard of care, or invasive surgeries which entail taking off portions from the skull to remove the clot-have similar mortality rates, which range from 30 to 80 % depending on the dimensions of the clot.

Seeking to enhance these death rates and surviving ICH patients’ quality of life, Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine, and his fellow workers produced and analyzed the brand new treatment method on sixty individuals at 12 hospitals in the usa, Canada, the united kingdom as well as Germany. They compared their results to that from 11 individuals who received only supportive care.

After neurologists diagnosed individuals in the treatment group with ICH at these hospitals, operating specialists drilled dime-sized openings in patients’ skulls near to the clot area. Using high-tech neuro-navigational computer software that provides detailed brain images, the physicians threaded catheters through the holes and directly into the clots. They used these catheters to drip t-PA to the clot for about three days at 1 of 2 doses, either 0.3 mg or 1 mg, every 8 hrs.

The study discovered that clot size in patients given either dose shrunk by more than half, compared to only 1 percent in subjects who received only supportive care. Comparison of daily CT scans showed that patients in the treatment method group whose catheters were most accurately placed over the longest part of the clot had the very best clot size reduction.

Those in the treatment group and also the supportive care group had about a 10 percent mortality rate at 30 days after treatment, less than the typically high mortality rates expected with this condition. After pursuing the patients out for 6 months, the researchers found that the treated patients scored significantly greater over a test that calculates the ability to function in daily life in comparison to people who received supportive care.

All round, Hanley says, the new treatment method appears to be a viable and promising option to the current standard treatments of supportive care or invasive surgery.

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