Journal article
Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure
Neurosurgery, Vol.84(6), pp.1157-1168
06/01/2019
DOI: 10.1093/neuros/nyz077
PMCID: PMC6537634
PMID: 30891610
Abstract
Minimally invasive surgery procedures, including stereotactic catheter aspiration and clearance of intracerebral hemorrhage (ICH) with recombinant tissue plasminogen activator hold a promise to improve outcome of supratentorial brain hemorrhage, a morbid and disabling type of stroke. A recently completed Phase III randomized trial showed improved mortality but was neutral on the primary outcome (modified Rankin scale score 0 to 3 at 1 yr).
To assess surgical performance and its impact on the extent of ICH evacuation and functional outcomes.
Univariate and multivariate models were used to assess the extent of hematoma evacuation efficacy in relation to mRS 0 to 3 outcome and postulated factors related to patient, disease, and protocol adherence in the surgical arm (n = 242) of the MISTIE trial.
Greater ICH reduction has a higher likelihood of achieving mRS of 0 to 3 with a minimum evacuation threshold of ≤15 mL end of treatment ICH volume or ≥70% volume reduction when controlling for disease severity factors. Mortality benefit was achieved at ≤30 mL end of treatment ICH volume, or >53% volume reduction. Initial hematoma volume, history of hypertension, irregular-shaped hematoma, number of alteplase doses given, surgical protocol deviations, and catheter manipulation problems were significant factors in failing to achieve ≤15 mL goal evacuation. Greater surgeon/site experiences were associated with avoiding poor hematoma evacuation.
This is the first surgical trial reporting thresholds for reduction of ICH volume correlating with improved mortality and functional outcomes. To realize the benefit of surgery, protocol objectives, surgeon education, technical enhancements, and case selection should be focused on this goal.
Details
- Title: Subtitle
- Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure
- Creators
- Issam A Awad - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisSean P Polster - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisJulián Carrión-Penagos - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisYing Cao - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisAgnieszka Stadnik - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisPatricia Lynn Money - Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OhioMaged D Fam - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisJanne Koskimäki - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisRomuald Girard - Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IllinoisKaren Lane - Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, MarylandNichol McBee - Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, MarylandWendy Ziai - Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, MarylandYi Hao - Johns Hopkins UniversityRobert Dodd - Department of Neurosurgery, Stanford University School of Medicine, Stanford, CaliforniaAndrew P Carlson - Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New MexicoPaul J Camarata - Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, KansasJean-Louis Caron - Department of Neurosurgery, University of Texas, San Antonio, TexasMark R Harrigan - Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AlabamaBarbara A Gregson - Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, United KingdomA David Mendelow - Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, United KingdomMario Zuccarello - Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OhioDaniel F Hanley - Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University Medical Institutions, Baltimore, MarylandMISTIE III Trial Investigators (Minimally Invasive Surgery Plus Rt-PA for ICH Evacuation Phase III)
- Contributors
- James C Torner (Contributor) - University of Iowa, Epidemiology
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.84(6), pp.1157-1168
- DOI
- 10.1093/neuros/nyz077
- PMID
- 30891610
- PMCID
- PMC6537634
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Grant note
- U01 NS080824 / NINDS NIH HHS
- Language
- English
- Date published
- 06/01/2019
- Academic Unit
- Neurology; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984214703602771
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