LOCAL LYSIS TREATMENT WITH PLASMINOGEN-AC TIVATOR (RT-PA) FOR SPONTANEOUS INTRACEREBRAL HEMORRHAGE - INDICATION AND LIMITATIONS

Twenty patients under went a regimen of stereotactic puncture and cons ecutive local lysis with recombinant tissue plasminogen activator (rt- PA) for their spontaneous intracerebral hemorrhage (ICH). Rt-PA was ad ministered via a stereotactically placed silicone catheter according t o a hematoma-size-related formula. There was no extensive intraoperati ve hematoma aspiration so that the capacity of rt-PA for blood-clot ly sis could be investigated. Fifteen patients were somnolent/stuporous o n admission and 5 comatose, the hematoma-size ranging from 3 x 3 x 4 c m up to 7 x 4 x 4 cm (mean: 5.1 x 3.9 x 3.5 cm). Control computed tomo graphy (CT) was performed on a daily basis, and in 19 patients the hem atoma showed complete or almost complete resolution on CT within 4 day s. The rt-PA dosage necessary ranged from 5 to 14 (mean: 8.5) mg. Rt-P A application was performed once in 1 patient, twice in 7, three times in 11 and four times in 1 patient. On follow-up after a mean of 7.2 m onths 3 patients had died (Glasgow Outcome Score - GOS I). Another was GOS II, 10 GOS III, 5 GOS IV and 1 had made an excellent recovery (GO S V). Patients who were somnolent or stuporous on admission or who exh ibited secondary deterioration of their level of consciousness benefit ted from the treatment protocol. Early postoperative mobilization and thereby reduction of secondary complications during the patient's stay in the intensive care unit appear to be possible. Comatose patients d id not benefit from this treatment and those should be treated conserv atively. Before becoming a clinical routine, a larger randomized study for the comparison between an rt-PA group and a conservatively treate d group of patients is necessary for the evaluation of safety and effi cacy of stereotactic rt-PA lysis for spontaneous ICH.