Hematoma Resorption in Intracerebral Hemorrhage: A Translational Overview on Pathophysiology, Biomarkers, and Innovative Therapies

Spontaneous intracerebral hemorrhage (ICH) is a severe cerebrovascular condition with limited therapeutic options. One of the major contributors to ICH pathophysiology and secondary brain injury is the toxicity of blood products. As a result, removing parenchymal blood has emerged as a potential strategy to reduce mortality and improve patient outcomes. While minimally invasive surgical techniques have shown promising results, their broader application is limited by stringent patient selection criteria and technical challenges. Consequently, a pharmacological approach aiming at modulating the endogenous clearance of blood is of particular interest. Recent advances, from experimental models to human studies, have enhanced our understanding of the mechanisms involved in spontaneous hematoma resorption, leading to the identification of several biomarkers and potential therapeutic targets. This narrative review takes a translational approach to provide an update on the current knowledge of hematoma resorption, including its natural history, underlying mechanisms, and associated imaging and biological biomarkers. Special focus will be given to the most promising pharmacomodulatory strategies.