| Objective Administration of the intravenous thrombolysis and emergency mechanical thrombectomy has enlarged the opened rate of occlusion vessels and improved the favorable outcomes.Furthermore,implantation of carotid artery stent and intracranial artery stent has been testified as a better alternation to avoid recurrent stroke.However,all of that can’t escape the complication of intracranial hemorrhage that will increase the risk of mortality and disability.Regardless of the application with intravenous thrombolysis and antithrombotic drugs,there exists some discrepancy in the conservative and surgical treatment between intracranial hemorrhage after infarction and spontaneous brain hemorrhage.Nowadays,there is still no based-evidence for management of intracranial hemorrhage after infarction.This study focuses on exploring the clinical effect of frameless stereotactic soft channel technology in the treatment of symptomatic intracranial hemorrhage transformation associated with acute ischemic stroke reperfusion,in order to provide clinical experience for the treatment of such patients.Methods A total of 15 cases were included by retrieval of the medical record system in our hospital from January 2020 to May 2022.Administration of free-hand bedside hematoma evacuation did not need the assistance of stereotaxic apparatus.And the improved perfusion-related methods included intravenous thrombolysis,emergency mechanical thrombectomy,balloon dilatation or stent implantation.Clinical efficacy and safety of this technique were examined.The safety indicators as follows: mortality,cause of death,intracranial re-hemorrhage,secondary brain infection,site of the drainage track,endotracheal intubation,tracheotomy and other systemic complications.Efficacy indicators as follows: changes for hematoma volume after drainage tube removal,hematoma clearance rate,change of Glasgow coma scale(GCS)at the point of intracranial hemorrhage occurrence,drainage tube removal and discharge,change for midline shift distance,favorable outcomes at following 3 and 6 months,the outcomes evaluated by the modified Rankin Scale(m RS)and m RS≤3 for favorable outcomes.Results Of the 15 patients,4 was application for intravenous thrombolysis,6 was for emergency mechanical thrombectomy,7 for balloon angioplasty and 6 for carotid stent implantation.All the patients acquired successful operation.The average operation time was 30(30-40)min and the mean time of drainage was(2.6±0.4)d.For the safety evaluation,no(0%)intracranial infection occurred,2(13.3%)emerged active hemorrhage,12(80%)was carried out tracheal intubation for airway management and other systemic complications included 3(20%)of deep vein thrombosis,4(26.7%)of pulmonary infection,1(6.3%)of gastrointestinal bleeding,4(26.7%)of death and 2(13.3%)of in-hospital death.For the efficacy results,the mean GCS after hemorrhage transformation was(6±0.6)points,mean GCS after drainage tube removal was(7.5±0.8)points and mean GCS at discharge was 10(6-12)points,and there existed statistical difference among them(P <0.001)and the discrepancy originating from intracranial hemorrhage GCS and discharge GCS(P=0.013)rather from intracranial GCS and post-drainage GCS(P=0.350).In addition,the mean volume of residual hematoma after drainage was 6.5(1.75-13.3)m L,which was significantly lower than 56.5(26-65)m L after intracranial hemorrhage(P=0.005).The mean rate of hematoma clearance was 87.5(68.0-94.3)%.And the mean shift distance of midline after hemorrhage transformation was(7.6±1.5)mm,which was higher than 3(0-6.4)mm after drainage tube removal(P=0.016).3patients(20%)acquired favorable outcomes at 3 months(m RS≤3)and 6(40%)at 6months,with no significant difference(P=0.213).Conclusion Frameless-Stereotactic Soft Channel Technology is simple,fast and safe.Administration of this method decreases the rate of mortality in the treatment of improved perfusion-related intracranial hemorrhage for acute ischemic stroke.And this novel operation significantly enlarges the efficiency of hematoma clearance and improves the favorable outcomes,followed. |
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