Objective: To investigate the clinical efficacy of clot aspiration in the treatment of intracerebral hemorrhage (ICH) by reviewing literatures.
Methods: All studies assigned into two groups of hard or soft tunnel aspiration of clots (HTAC or STAC) on the basis of surgical approaches were obtained by searching four major Chinese medical databases. And the surgical outcomes were descriptively analyzed.
Results: A total of 1205 reports (72,855 patients) met the eligibility criteria. The trials (34.0%) with 80% - 89% of clot removal ratio were the most in all HTAC papers and those (37.7%) with 50% - 69% of clot removal ratio were the most in all STAC papers. The mortality and re-bleeding rate in HTAC and STAC group were 14.0% vs 14.5% and 7.2% vs 7.6% respectively (P > 0.05). As compared with the conventional medical group, the mortalities in HTAC and STAC groups were 13.4% vs 36.0% and 14.3% vs 36.1% (P < 0.001) and the re-bleeding rates 9.3% vs 10.6% and 12.2% vs 16.1% (P > 0.05) respectively. As compared with the craniotomy group, the mortalities in HTAC and STAC groups were 14.4% vs 24.1% and 16.7% vs 24.8% (P < 0.01) and the re-bleeding rates 9.1% vs 13.9% (P > 0.05) and 7.1% vs 14.7% (P < 0.01) respectively.
Conclusion: Aspiration of clots can effectively remove hematoma and reduce the mortality. But it does not increase the risk of re-bleeding. The outcome of HTAC is similar to that of STAC. HTAC has the advantage of clot removal over STAC.