Evacuation time course and residual hematoma volume: dual correlates of functional independence in stereotactic aspiration with thrombolysis for intracerebral hemorrhage

BACKGROUND: To examine the influence of time from symptom onset to aspiration (TSTA), post-aspiration residual hematoma volume (RHV), duration of thrombolysis (DT), and residual hematoma volume at treatment completion on mid- to long-term functional outcomes in patients with spontaneous intracerebral hemorrhage undergoing stereotactic catheter aspiration and thrombolysis. METHODS: We retrospectively analyzed clinical and imaging data from 102 patients with supratentorial hematomas (volume ≥20 mL). Associations of post-aspiration volume, post-treatment volume, TSTA, and DT with functional independence (FI; modified Rankin Scale score ≤2) at 6 and 12 months were assessed in the full cohort and a subgroup with post-treatment volume ≤15 mL. RESULTS: Reduced post-aspiration volume (OR = 0.897, p = 0.002) and prolonged TSTA (OR = 1.016, p = 0.034) were found to be independent predictors of 6-month FI. Prolonged DT also independently predicted a reduced likelihood of 12-month FI (OR = 0.976, p = 0.014). Post-treatment volume was associated with 12-month FI in the full cohort (OR = 0.876, p = 0.041), but not in the subgroup with a volume of ≤15 mL. CONCLUSION: Effective evacuation of the hematoma during surgery promotes early neurological recovery. Long-term functional independence (FI) is more strongly correlated with final hematoma volume than with initial evacuation. Interestingly, achieving a residual volume of 15 ml or less reduced the link between further volume reduction and functional outcomes. Extended DT independently predicted worse long-term outcomes.