Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial

Hanley, Daniel F.; Thompson, Richard E.; Muschelli, John; Rosenblum, Michael; McBee, Nichol; Lane, Karen; Bistran-Hall, Amanda J.; Mayo, Steven; Keyl, Penelope M.; Gandhi, Dheeraj; Morgan, Tommie J.; Ullman, Natalie; Mould, W. Andrew; Carhuapoma, J. Ricardo; Kase, Carlos S.; Ziai, Wendy; Thompson, Carol B.; Yenokyan, Gayane; Huang, Emily J.; Broaddus, William C.; Graham, Roger A.; Aldrich, E. François; Dodd, Robert; Wijman, Cristanne Ac; Caron, Jean-Louis; Huang, Judy; Camarata, Paul J.; Mendelow, A. D.; Gregson, Barbara; Janis, Scott; Vespa, Paul; Martin, Neil A.; Awad, Issam A.; Zuccarello, Mario

doi:10.1016/s1474-4422(16)30234-4

Cited by 378 publications

(422 citation statements)

References 35 publications

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“…The MISTIE phase II trial importantly showed no significant increase in symptomatic bleeding or infections in the surgical group and a trend towards improved functional outcomes with the surgical intervention. 23 For now, only conventional surgery is offered in the UK and existing data can help to guide patient selection.…”

Section: Neurosurgerymentioning

confidence: 99%

Hyperacute management of intracerebral haemorrhage

Paroutoglou

Parry‐Jones

2018

Clinical Medicine

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s9-s12 STROKE on the day of admission than ischaemic strokes (odds ratio: 7.27, 95% CI: 6.31-8.37, p<0.001).2 However, there has been a growing interest in ICH in the stroke research community and findings from recent studies suggest that a more active approach to this patient group is now warranted. We will focus this review on evidence for key interventions in the hyperacute phase of ICH management, that is, the first 24 hours after symptom onset. Early neurological deteriorationIn ICH, a key pathophysiological difference from ischaemic stroke is the presence within the fixed volume of the cranium of a space-occupying lesion, initially composed of the haematoma and subsequently, an increasing volume of vasogenic oedema. 4Should the reserve of space within the cranium be exhausted (Monro-Kellie doctrine), intracranial pressure will begin to rise and fatal brain herniation syndromes may then occur. Baseline haematoma volume is an important predictor of survival and functional outcomes but subsequent early complications that increase intracranial pressure can cause early neurological deterioration in up to half of patients, depending on how it is defined and study duration. 5,6 Haematoma expansion (Fig 1 ) is a principal cause of deterioration in the first 24 hours after onset, with studies indicating that up to 30% of patients demonstrate significant haematoma expansion within hours of onset, which worsens prognosis. 7 Obstructive hydrocephalus may occur with occlusion of cerebrospinal fluid flow, either by occlusion of the ventricular system by intraventricular haemorrhage or extrinsic compression, especially at the third and fourth ventricles. Finally, for larger haematomas in the subacute phase, the addition of Intracerebral haemorrhage causes 1 in 10 strokes, but has the worst overall outcomes of all stroke subtypes. Baseline haematoma volume is a key prognostic factor and early complications -such as haematoma expansion, obstructive hydrocephalus and perihaematomal oedema -may worsen outcome. There is evidence that withdrawal of care may occur more often in intracerebral haemorrhage than ischaemic stroke independent of premorbid health and stroke severity. However, recent evidence shows that reversal of anticoagulants, intensive blood pressure lowering and surgery in carefully selected cases may improve outcomes. Ongoing research may also provide evidence for new medical treatments and minimally invasive approaches to surgery. Effective implementation of evidence-based care to intracerebral haemorrhage patients can be diffi cult but quality improvement methodology can help to achieve maximal benefi t.

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Section: Neurosurgerymentioning

confidence: 99%

Hyperacute management of intracerebral haemorrhage

Paroutoglou

Parry‐Jones

2018

Clinical Medicine

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“…Mortality reaches approximately 50% within the first 3 months and most survivors are left with severe disability (1–3). Despite major advances in the acute emergency neurological life support of patients with ICH, the optimal surgical management of these patients remains controversial (4–6). …”

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confidence: 99%

“…Because of this, multiple surgical approaches have been investigated with varying degree of success. Investigated procedures include conventional craniotomy, stereotactic guidance with aspiration and thrombolysis, image-guided stereotactic endoscopic aspiration, and decompressive craniectomy (4–6). …”

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confidence: 99%

“…Despite negative findings, further stratification through subgroup analyses of STICH II may identify a group of patients responsive to open hematoma evacuation. In fact, large meta-analyses that included STICH II data suggest surgical benefit for select subgroups of patients, including those with poorer prognosis at presentation, those with secondary deterioration attributed to hematoma expansion, and those with superficial hematomas without intraventricular extension (5, 6, 9, 12). …”

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confidence: 99%

“…The intraoperative stereotactic computed tomography-guided endoscopic surgery (ICES) study suggested that early computerized tomographic image-guided endoscopic surgery is a safe and effective method in select cases to remove acute intracerebral hematomas (5). Similarly, the minimally invasive surgery plus alteplase ® in intracerebral hemorrhage evacuation (MISTIE) trial found catheter-based hematoma removal to be safe and promising (6). However, questions remain regarding the surgical optimization of these minimally invasive techniques, including patient selection and timing of surgery.…”

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confidence: 99%

See 2 more Smart Citations

Spontaneous Intracerebral Hemorrhage: Should We Operate?

Babi

James

2017

Front. Neurol.

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Cerebral Intraparenchymal Hemorrhage

Gross

Jankowitz

Friedlander

2019

JAMA

233

177

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pontaneous intraparenchymal hemorrhage (IPH) is relatively common and has devastating consequences. Recognition of risk factors (eg, hypertension), early distinction from an ischemic event, and identification of clinical features that can worsen IPH complications is important in optimizing outcomes from IPH. This review examines the pathophysiology of and management options for IPH, with the intent of helping clinicians better manage the condition. IPH accounts for 6.5% to 19.6% of cases of stroke 1,2 but is associated with the greatest rate of mortality; 1-year survival from IPH is approximately 40%, 3-5 and 10-year survival is 24%. 4 Across several studies, the rate of functional independence at follow-up varied from 12% to 39%. 5 A meta-analysis of 36 studies reported an incidence of IPH of 24.6 per 100 000 person-years (range, 1.8-129.6), and the rate was significantly higher in Asian and older populations. 5 MethodsThe PubMed database was searched on September 1, 2018, using the terms intracerebral hemorrhage and intraparenchymal hemorrhage, for English-language studies of the pathophysiology, epidemiology, and management of IPH published after January 1, 2015. Large population epidemiologic studies, randomized trials, and formal treatment guidelines were reviewed. Relevant references published before January 1, 2015, were extracted and also reviewed. Studies providing only aggregate data for all types of hemorrhagic stroke (including subarachnoid hemorrhage) were excluded. This review was based on 77 referenced articles, including 11 clinical trials, 10 meta-analyses, 41 observational studies, 2 guidelines, and 13 other reports.

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Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial

Cited by 378 publications

References 35 publications

Hyperacute management of intracerebral haemorrhage

Hyperacute management of intracerebral haemorrhage

Spontaneous Intracerebral Hemorrhage: Should We Operate?

Cerebral Intraparenchymal Hemorrhage

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