Free-hand bedside catheter evacuation without 3D reconstruction for extensive revascularization-associated hemorrhage after ischemic stroke

Objective

To evaluate the feasibility of free-hand bedside catheterization using axial computed tomography (CT) in patients with brain hemorrhage after ischemic revascularization.

Methods

Patients who received revascularization therapy and underwent bedside catheterization were consecutively screened from December 2020 to July 2022. Revascularization included intravenous thrombolysis with or without mechanical thrombectomy, balloon angioplasty, and stenting. The catheter trajectory was designed according to the axial CT along the long axis of the hematoma body and projected onto the scalp at the calculated distance and angle. Urokinase was used locally to drain the hematoma.

Results

In 12 patients (mean age 66 ± 8 years), an 86% reduction in hematoma volume was found after catheter drainage, from 48.6 ± 20.4 ml to 6.7 ± 5.7 ml (P＜0.001). In accordance with the reduction of the hematoma volume, the Glasgow Coma Scale improved from 7 (6.5–8) to 10 (7–10.5) (P = 0.031). Four patients (33.3%) achieved good outcomes (modified Rankin Scale 0–3) at the 180-day follow-up. All-cause mortality was 25%. One patient experienced active hemorrhage. No bacterial brain infections were observed.

Conclusions

Free-hand bedside catheterization according to axial CT localization is feasible for treating extensive revascularization-related hematoma after ischemic stroke.