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A minimally invasive procedure paired with tissue plasminogen activator (tPA) to remove blood clots in brain tissue after hemorrhagic stroke appears safe and effective, and may even lead to cost savings, a phase II trial suggested.

The procedure involves guiding a catheter through a tiny hole in the skull, dousing the hematoma with tPA, both intraventricularly and intracerebrally, and aspirating the clot.

Patients randomized to surgery plus tPA had a significant reduction in hematoma volume compared with patients receiving standard post-stroke care (19.6 cm3 versus 40.7 cm3, P<0.001), according Daniel Hanley, MD, from Johns Hopkins School of Medicine in Baltimore, and colleagues.

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