For faster drainage of hemorrhagic strokes, add ultrasound: study By Reuters Health March 2, 2010

Ultrasound is often used to lyse clots when treating peripheral arterial disease and for middle cerebral artery occlusion, Dr. David W. Newell said during a news conference on February 25 at the American Stroke Association's International Stroke Conference in San Antonio, Texas.

However, it has not been extensively tested in intracerebral hemorrhage, and it has been unclear which delivery method would be best.

Dr. Newell and his team "placed the tip of the ultrasound probe directly into the brain guided by a new neuronavigation device" akin to a GPS system, he said.

Dr. Newell, from the Swedish Neuroscience Institute in Seattle, and his colleagues studied nine patients who had hemorrhages of at least 25 cc and were treated with tPA in divided doses for 24 hours.

For 24 hours, they placed a ventricular drainage catheter and an ultrasound microcatheter directly into the brain parenchyma through a burr hole, "spreading out the ultrasound fibers" in patients with intracranial hemorrhage, or else targeted the largest clot in the three patients with intraventricular hemorrhage.

In patients with intracranial hemorrhage, there was a 60% decrease in hemorrhage size over the first 24 hours, while size decreased by 45% in patients with intraventricular hemorrhage, Dr. Newell said, faster than what has been observed historically. There were no significant rebleeding events in any of the patients.

Seven of the nine patients improved clinically within 30 days, one died, and one failed to improve despite the marked decrease in hemorrhage size.

The next step, Dr. Newell said, will be to design a catheter specifically for brain blood clot removal and to perform a randomized, placebo-controlled trial in a larger number of patients.

Last Updated: 2010-02-26 18:50:19 -0400 (Reuters Health)

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