A new treatment for stroke patients with intracerebral hemorrhage (ICH), which combines minimally invasive surgery, linked imaging techniques similar to having a 'GPS for the brain', and anticoagulant t-PA, seems to be safe and effective, according to the results of a multicentre clinical trial conducted by researchers at Johns Hopkins University in the United States, and presented for the first time last week at the European Stroke Conference held in Hamburg (Germany).

This new treatment was developed for patients with intracerebral hemorrhage (ICH), a bleeding in the brain that causes a clot in brain tissue. This clot increases the pressure and filters out inflammatory chemicals that can cause irreversible brain damage, which could lead to death or disability of the patient.

The usual treatment for ICH, both palliative care such as control of blood pressure and ventilation - which is considered the standard treatment - as invasive surgeries -which involve removing parts of the skull to remove the clot- have similar mortality rates, ranging from 30 to 80%, depending on the size of the clot.

To improve these mortality rates and the quality of life of these patients, the professor of neurology at Johns Hopkins University Daniel Hanley and his team developed and tested a new treatment in 60 patients from 12 hospitals in the United States, Canada, United Kingdom and Germany. They then compared their results with those of 11 patients who received only palliative care.

After neurologists diagnosed patients in the ICH treatment group at these hospitals, surgeons drilled holes the size of a small coin into the skulls of patients near the location of the clot, and with a 'software' of high neuro-navigational technology, which provides detailed images of the brain, doctors strung catheters through those holes directly into the clots. They used these catheters to deliver a t-PA drip into the clot for up to three days, to one of two doses: 0.3 milligrams or 1 milligram every eight hours.

The researchers found that the size of the clot in patients treated with both doses more than doubled, compared to only 1% in patients who received only palliative care.

Comparison of daily CT scanners showed that patients in the treatment groups whose catheters were located most appropriately through the longest part of the coagulum had the most effective reduction in tumor size.

The new treatment seems to be a viable and promising alterative to palliative care or invasive surgery, and allows the patient to recover better

After following these patients for six months, the researchers found that treated patients achieved significantly higher scores on a test that measured the ability to function in daily life, compared to those who received only palliative care.

Hanley says that the new treatment seems to be a viable and promising alternative to the current standard treatment of palliative care or invasive surgery, since reducing the size of the clot with a minimally invasive system is key for the patient to recover properly.

Cutting Edge Blood Clot Removal (November 2019).