[Local thrombolytic treatment of spontaneous intracerebral hemorrhage with plasminogen activator (rt-PA). Indications and limits].

Twenty patients underwent a regimen of stereotactic puncture and consecutive local lysis with recombinant tissue plasminogen activator (rt-PA) for their spontaneous intracerebral hemorrhage (ICH). Rt-PA was administered via a stereotactically placed silicone catheter according to a hematoma-size-related formula. There was no extensive intraoperative hematoma aspiration so that the capacity of rt-PA for blood-clot lysis could be investigated. Fifteen patients were somnolent/stuporous on admission and 5 comatose, the hematoma-size ranging from 3 x 3 x 4 cm up to 7 x 4 x 4 cm (mean: 5.1 x 3.9 x 3.5 cm). Control computed tomography (CT) was performed on a daily basis, and in 19 patients the hematoma showed complete or almost complete resolution on CT within 4 days. The rt-PA dosage necessary ranged from 5 to 14 (mean: 8.5) mg. Rt-PA application was performed once in 1 patients, twice in 7, three times in 11 and four times in 1 patient. On follow-up after a mean of 7.2 months 3 patients had died (Glasgow Outcome Score--GOS I). Another was GOS II, 10 GOS III, 5 GOS IV and 1 had made an excellent recovery (GOS V). Patients who were somnolent or stuporous on admission or who exhibited secondary deterioration of their level of consciousness benefitted from the treatment protocol. Early postoperative mobilization and thereby reduction of secondary complications during the patient's stay in the intensive care unit appear to be possible. Comatose patients did not benefit from this treatment and those should be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)