Intrahematomal Ultrasound Enhances RtPA-Fibrinolysis in a Porcine Model of Intracerebral Hemorrhage

Autor: Karl-Friedrich Kreitner, Axel Heimann, Tristan Klodt, Christian Schneider, Oliver Kempski, Yasemin Tanyildizi, Naureen Keric, Florian Ringel, Hammoud Elmehdawi, Andrea Kronfeld, Clemens Sommer, Julia Masomi-Bornwasser, Harald Krenzlin
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Journal of Clinical Medicine
Volume 10
Issue 4
Journal of Clinical Medicine, Vol 10, Iss 563, p 563 (2021)
ISSN: 2077-0383
DOI: 10.3390/jcm10040563
Popis: Catheter-based ultrasound-thrombolysis has been successfully used in a small clinical trial in order to enhance recombinant tissue plasminogen activator (rtPA)-fibrinolysis, for the treatment of spontaneous intracerebral hemorrhages (ICHs). The aim of this study was to investigate the ultra-early effects of ultrasound on hematoma and the surrounding brain tissue in a porcine ICH-model. To achieve this, 21 pigs with a right frontal ICH were randomly assigned to four groups: (1) drainage (n = 3), (2) drainage + rtPA (n = 6), (3) drainage + ultrasound (n = 6), and (4) drainage + ultrasound + rtPA (n = 6). The hematoma volume assessment was performed using cranial MRI before and after the treatments. Subsequently, the brain sections were analyzed using HE-staining and immunohistochemistry. The combined treatment using rtPA and ultrasound led to a significantly higher hematoma reduction (62 ± 5%) compared to the other groups (Group 1: 2 ± 1%
Group 2: 30 ± 12%
Group 3: 18 ± 8% (p <
0.0001)). In all groups, the MRI revealed an increase in diffusion restriction but neither hyper- or hypoperfusion, nor perihematomal edema. HE stains showed perihematomal microhemorrhages were equally distributed in each group, while edema was more pronounced within the control group. Immunohistochemistry did not reveal any ultra-early side effects. The combined therapy of drainage, rtPA and ultrasound is a safe and effective technique for hematoma-reduction and protection of the perihematomal tissue in regard to ultra-early effects.
Databáze: OpenAIRE
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