Abstract
Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, which leads to a high rate of mortality and poor neurological outcomes worldwide. Thrombolytic evacuation with urokinase-type plasminogen activator (uPA) or tissue-type plasminogen activator (tPA) has been showed to be a hopeful treatment for ICH. However, to the best of our knowledge, no clinical trials were reported to compare the efficacy and safety of these two fibrinolytics administrated following minimally invasive stereotactic puncture (MISP) in patients with spontaneous basal ganglia ICH. Therefore, the authors intended here to evaluate the differential impact of uPA and tPA in a retrospective study. In the present study, a total of 86 patients with spontaneous ICH in basal ganglia using MISP received either uPA (uPA group, n = 45) or tPA (tPA group, n = 41), respectively. The clinical baseline characteristics prior to the operation were collected. In addition, therapeutic responses were assessed by the short-term outcomes within 30 days postoperation, as well as long-term outcomes at 1 year postoperation. Our findings showed that, in comparison with tPA, uPA was able to better promote hematoma evacuation and ameliorate perihematomal edema, but the differences were not statistically significant. Moreover, the long-term functional outcomes of both groups were similar, with no statistical difference. In conclusion, these results provide evidence supporting that uPA and tPA are similar in the efficacy and safety for thrombolytic evacuation in combination with MISP in patients with spontaneous basal ganglia ICH.
Highlights
Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of cerebrovascular diseases with extremely high mortality, severe disability in the surviving patients and little effective treatment [1,2,3]
According to the inclusion and exclusion criteria, a total of 86 eligible in-hospital patients (47 males, 39 females) who were diagnosed with spontaneous intracerebral hemorrhage (ICH) in basal ganglia from January 2014 to June 2015 were enrolled in the clinical trial. 45 individuals who received minimally invasive stereotactic puncture (MISP) + urokinase-type plasminogen activator (uPA) were assigned to the uPA group, and the remaining 41 individuals with MISP + type plasminogen activator (tPA) were assigned to the tPA group
The mass effect caused by intracranial hematoma and secondary perihematomal edema (PHE) could contribute to brain damage, such as intracranial hypertension or cerebral hernia, which is significantly associated with mortality, morbidity, and poor functional outcomes after ICH [20, 21]
Summary
Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of cerebrovascular diseases with extremely high mortality, severe disability in the surviving patients and little effective treatment [1,2,3]. A powerful evidence provided by the results of Surgery for Primary Supratentorial Intracerebral Hemorrhage demonstrated that surgery plus medical management significantly reduced the mortality and morbidity at final follow-up when compared to routine medical management alone in patients with supratentorial ICH [11]. To the best of our knowledge, no clinical trials have been carried out to compare the differential effect of these two fibrinolytic agents administrated following MISP in patients with spontaneous basal ganglia ICH. We decided to test this hypothesis in a retrospective clinical trial
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