For the
fibrinolytic therapy of intracerebral
hematomas (ICH) using recombinant
tissue plasminogen activator (rtPA), a
catheter position in the core of the
hematoma along the largest clot diameter was assumed to be optimal for an effective clot lysis. However, it never had been proven that core position indeed enhances clot lysis if compared with less optimal
catheter positions. In this study, the impact of the
catheter position on the effectiveness and on the time course of clot lysis was evaluated. We analyzed the
catheter position using a relative error calculating the distance perpendicular to the
catheter's center in relation to
hematoma's diameter and evaluated the relative
hematoma volume reduction (RVR). The correlation of the RVR with the
catheter position was evaluated. Additionally, we tried to identify patterns of clot lysis with different
catheter positions. The patient's outcome at discharge was evaluated using the Glasgow outcome score. A total of 105 patients were included in the study. The mean
hematoma volume was 56 ml. The overall RVR was 62.7 %. In 69 patients, a
catheter position in the core of the clot was achieved. We found no significant correlation between
catheter position and
hematoma RVR (linear regression, p = 0.14). Core
catheter position leads to more symmetrical
hematoma RVR. Faster clot lysis happens in the vicinity of the
catheter openings. We found no significant difference in the patient's outcome dependent on the
catheter position (linear regression, p = 0.90). The
catheter position in the core of the
hematoma along its largest diameter does not significantly influence the effectiveness of clot lysis after rtPA application.