ICH

Under general anaesthesia, after burr hole placement, we used image guidance to place a rigid cannula within the middle two-thirds of the overall haematoma short axis to a targeted point 75% or greater along the long axis of the clot, through a burr hole or twist drill opening. Clot aspiration was done with a 10 mL handheld syringe until first resistance. A soft catheter was then placed with image guidance into the residual haematoma, tunnelled subcutaneously, and connected to a three-way stopcock and closed drainage system. Postoperative CT was done to confirm positioning of the soft catheter and stability of the residual haematoma and catheter tract. If the catheter did not engage the clot, it was removed and repositioned. 6 h or more after catheter placement, we administered alteplase directly into the clot through the catheter, at 1·0 mg in 1 mL followed by 3 mL flush every 8 h, for up to nine doses. Administration of alteplase was stopped when the trial-defined surgical aim (residual haematoma ≤15 mL) was reached, nine doses of alteplase were given, or on occurrence of a clinically symptomatic rebleeding event, defined as a sustained decrease of more than 2 points on the GCS motor score, with CT-demonstrated enlargement of the intracerebral haemorrhage. All doses were followed by a 3 mL flush of preservative-free normal saline, and the system was closed for 1 h to allow drug–clot interaction and then reopened to allow for gravitational drainage.

No result found