Minimally invasive surgery plus rt-PA for ICH evacuatio

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 141

Inclusion Criteria

1. Aged 18 - 80 years, either sex
2. Glasgow Coma Scale (GCS) less than 14 or a National Institutes of Health Stroke Scale (NIHSS) (including the use of distal hand measures) greater than 6
3. Spontaneous supratentorial ICH greater than 20 cc
4. Symptoms less than 12 hours prior to diagnostic CT scan (an unknown time of symptom onset is exclusionary)
5. Intention to initiate surgery within 48 hours after diagnostic CT
6. First dose can be given within 54 hours of diagnostic CT
7. Six-hour clot size equal to the most previous clot size + 5 cc (as determined by additional CT scan at least 6 hours after the initial stability scan (A*B*C)/2 method)
8. Systolic blood pressure (SBP) less than 200 mmHg sustained for 6 hours recorded closest to the time of randomisation
9. Historical Rankin score of 0 or 1
10. Negative pregnancy test

Exclusion Criteria

1. Infratentorial hemorrhage including brainstem (any involvement of the midbrain or lower brainstem as demonstrated by radiograph or complete third nerve palsy)
2. Patients with platelet count less than 100,000, international normalised ratio (INR) greater than 1.7, or an elevated prothrombin time (PT) or activated partial thromboplastin time (APTT) (reversal of coumadin is permitted but the patient must not require coumadin during the acute hospitalisation). Irreversible coagulopathy either due to medical condition or prior to randomiation (patient must have a sustained INR less than 1.7 using short- and long-acting procoagulants [Novoseven, FFP, and/or vitamin K]).
3. Clotting disorders
4. Any concurrent serious illness that would interfere with the safety assessments including hepatic, renal, gastroenteroligic, respiratory, cardiovascular, endocrinologic, immunologic, and haematologic disease
5. Patients with a mechanical valve
6. Patients with unstable mass or evolving intracranial compartment syndrome
7. Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly
8. Greater than 80 years (higher incidence of amyloid)
9. Under 18 years of age (high incidence of occult vascular malformation)
10. Pregnant (positive pregnancy test) or lactating females (likelihood of altered coagulation function associated with the high oestrogen/progesterone state)
11. Irreversibly impaired brainstem function (bilateral fixed, dilated pupils and extensor motor posturing), GCS less than or equal to 4
12. Historical Rankin score greater than or equal to 2
13. Intraventricular haemorrhage requiring external ventricular drainage
14. Internal bleeding, involving retroperitoneal sites, or the gastrointestinal, genitourinary, or respiratory tracts
15. Superficial or surface bleeding, observed mainly at vascular puncture and access sites (e.g., venous cutdowns, arterial punctures) or site of recent surgical intervention
16. Known risk for embolisation, including history of left heart thrombus, mitral stenosis with atrial fibrillation, acute pericarditis, and subacute bacterial endocarditis
17. In the investigator's opinion, the patient is unstable and would benefit from a specific intervention rather than supportive care plus or minus endoscopic or MIS+rtPA
18. Prior enrolment in the study
19. Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated
20. Participation in another simultaneous trial of ICH treatment

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method

Secondary Outcome Measures

Name	Time	Method

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