Use of intralesional tPA in spontaneous intracerebral hemorrhage: retrospective analysis.

INTRODUCTION: Neurosurgical treatment of spontaneous intracerebral hemorrhage (ICH) is controversial, with a lack of evidence-based guidelines contributing to the high variety of treatments. In our study we examine the outcome and complication from use of intralesional tissue plasminogen activator (IL tPA). METHOD: Patients who have been treated with IL tPA for spontaneous ICH were reviewed retrospectively. We compared clot sizes before and after tPA infusion, and outcome based on the modified Rankin score. RESULTS: Nine patients received IL tPA during the period 1999-2009. No immediate complications with use of IL tPA were found. There was a statistically significant volume reduction in clot sizes on computed tomography. Four patients recovered to independent functional status. Three patients were discharged to SNF, and two patients died as a result of ICH. Our results appear to demonstrate superior outcome to supportive management and no worse result than surgical management. CONCLUSION: It appears a subset of ICH patients benefits from use of IL tPA. This study demonstrates that IL tPA use is safe and has the potential to improve outcome compared to conservative management without the risk of surgical complications. Our patient size is small, and larger prospective studies are needed to provide solid guidelines for management of ICH.