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Abstract
Introduction Spontaneous intracerebral hemorrhage (ICH) has been associated with high rates of morbidity and mortality and is responsible for 10–15% of all stroke cases. Larger volumes of hemorrhage correlate with poorer outcome, but many treatment options, such as craniotomy, have not demonstrated significant clinical benefits. However, some minimally invasive techniques for ICH removal have shown a positive relationship with hemorrhage volume reduction and patient outcome. The recently approved Apollo System provides a minimally invasive approach for continuous fluid removal. Reported herein is a case review of early experience using the Apollo System in the endoscopic assisted, neuro-navigation guided evacuation of ICH.
Methods This was a retrospective case review of consecutively enrolled patients treated with the Apollo™ System since October 2014. Baseline characteristics, clinical performance, safety, and follow up data were assessed. Volume of hemorrhage was calculated using the A*B*C/2 method. A grading scale for volume of clot removed is described.
Results To date 11 patients were identified and met analysis criteria. 27.3% were female. Mean age was 50.9 ± 16.2. Hemorrhage location comprised of 81.8% basal ganglia, 9.1% ventricular circulation, 9.1% other. Mean clot volume at baseline was 40.8 ± 32.4 cc. Immediate post-procedure, mean clot volume was 5.5 ± 8.9 cc with a percent clot reduction average of 91.4 ± 8.2% (p = 0.0020), see example pre- and post-treatment CT scan in Figure 1. Nine out of ten (9/10) patients had a final clot volume below 15 cc. Following the procedure, only 1 patient required the need for shunt placement and 45.5% of patients were discharged home. Mean length of stay in the ICU was 8.3 ± 5.0 days.
Conclusion Preliminary experience using the Apollo™ System in the evacuation of ICH shows promising results in rapidly reducing overall clot volume with a favorable safety profile and ICU stay compared with historical controls. Further study is required to determine the association between the reduction in clot volume and outcome measures such as length of hospital stay and clinical recovery.
Disclosures R. Ryan: 2; C; Penumbra, Inc.