Minimally invasive surgical management of patients with cerebral hemorrhage after PCI and literature review

Abstract

Background

Postoperative bleeding after percutaneous coronary intervention (PCI) is a major early mortality factor for patients, and cerebral haemorrhage is one of the most dangerous and serious one, and there is no effective treatment guideline and expert consensus for post-PCI cerebral haemorrhage.

Case presentation

The Third Hospital of Hebei Medical University admitted two patients with post-PCI cerebral haemorrhage from October 2023 to July 2024, and the patients were treated with minimally invasive drilling and drainage under stereotactic positioning. Past medical history showed that the patients underwent PCI, and preoperative CT confirmed acute cerebral haemorrhage, and the patients were treated with minimally invasive drilling and drainage under stereotactic positioning, and they recovered well after the operation.

Conclusion

For patients with large amount of cerebral haemorrhage or even cerebral herniation, the necessity of surgical treatment becomes more prominent. In the same time, Minimally invasive surgical management could take better prognosis for patients.

Percutaneous coronary intervention (PCI) is widely used in clinical practice, but a serious complication, bleeding, often occurs after PCI. Post-PCI bleeding is the most important factor in early death, and cerebral haemorrhage is the most dangerous and fatal one [1]. The choice of treatment for patients undergoing PCI is made difficult by the fact that they are often subjected to DAPT, which results in coagulation abnormalities and an elevated risk of haemorrhage. Usually, for patients with a small amount of cerebral haemorrhage, conservative medical treatment including nerve nutrition, dehydration to lower the cranial pressure, and prevention of cerebral vasospasm are given priority, but when a large amount of cerebral haemorrhage occurs or even cerebral herniation is formed in the patient, surgical treatment becomes an important and should be considered as a priority treatment modality, including craniectomy for haematoma removal and decompression of debridement flap, minimally invasive drilling and drainage under stereotactic positioning, and neuroendoscopic haematoma removal [[2], [3], [4]], there is no expert consensus or guideline for the treatment of these patients, this paper aims to discuss the choice of treatment options for these patients, and adopts two patients hospitalised in our hospital, using minimally invasive drilling and drainage under stereotactic positioning, the patients’ postoperative haematomas were better absorbed, and the prognosis was good, with no obvious neurological impairment left.