Background and Purpose: 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. Methods: Patients with a VKA-related ICH > 20 ml who received bedside hematoma evacuation treatment (n = 21) at the University Medical Center Freiburg were retrospectively included for analysis and compared to a historical control group (n = 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. Results: 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 (p = 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); p = 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); p < 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); p = 0.274] or mRS at discharge [MIS: 5 (IQR: 4-5) and 5 (IQR: 4-5); p = 0.949]. No hematoma expansion was observed. The catheter had to be replaced in 1 patient (6%). Conclusions: 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. Clinical Trial Registration: DRKS00007908 (German Clinical Trial Register; www.drks.de).

中文翻译：

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维生素 K 拮抗剂相关脑出血的床旁导管血肿清除：一种安全可行的方法。


背景和目的：尽管手术干预通常无法改善脑出血（ICH）患者的预后，但微创手术（MIS）的使用已显示出有希望的结果。然而，维生素 K 拮抗剂 (VKA) 相关的脑出血患者在手术治疗试验中代表性不足。因此，我们评估了床边 MIS 方法（包括在 VKA 相关 ICH 中局部应用尿激酶）的安全性和有效性。方法：回顾性纳入弗莱堡大学医学中心接受床边血肿清除治疗的 VKA 相关 ICH > 20 ml 的患者 (n = 21) 进行分析，并与从机构中选择的历史对照组 (n = 35) 进行比较数据库（埃尔兰根大学医学中心）根据相同的纳入标准。进行倾向评分匹配以获得可比较的队列。分析了血肿和出血周围水肿（PHE）体积的演变、中线移位以及不良事件的发生。此外，我们还评估了出院时记录的改良 Rankin 量表和 NIHSS 评分。结果：倾向评分匹配显示每组 16 名患者具有均衡的特征。对照组入院时的中位 ICH 体积为 45.7（IQR：24.2-56.7）ml，治疗组为 48.4（IQR：28.7-59.6）ml（p = 0.327）。治疗组第 7 天的 ICH 体积不太明显 [MIS：23.2 ml（IQR：15.8-32.3）对比对照组：43.2 ml（IQR：27.5-52.4）； p = 0.013]，截至第 7 天的中线移位增加也是如此 [MIS：-3.75 mM（IQR：-4.25 至 -2）与对照：1 mM（IQR：0-2）； p < 0.001]。第 7 天的 PHE 体积没有观察到组间差异 [MIS：42.4 ml（IQR：25.0-72.3）对比对照组：31.0 ml（IQR：18.8-53.8）； p = 0。274] 或出院时 mRS [MIS：5（IQR：4-5）和 5（IQR：4-5）； p = 0.949]。未观察到血肿扩大。 1 名患者 (6%) 必须更换导管。结论：对于大量 VKA 相关的 ICH 病例，床旁导管血肿清除随后用尿激酶局部溶栓似乎是可行且安全的。有必要进行进一步的研究来评估与该技术相关的功能结果。临床试验注册：DRKS00007908（德国临床试验注册处；www.drks.de）。