Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage.
Adult
Aged
Basal Ganglia Hemorrhage
/ diagnostic imaging
Case-Control Studies
Cohort Studies
Disease Management
Female
Hospital Mortality
/ trends
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
/ methods
Neuroendoscopy
/ methods
Pilot Projects
Prospective Studies
Retrospective Studies
Treatment Outcome
endoscopy
hemorrhage
standards
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
20
09
2018
revised:
31
10
2018
accepted:
05
11
2018
pubmed:
9
1
2019
medline:
31
7
2019
entrez:
9
1
2019
Statut:
ppublish
Résumé
We conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH). We evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months. Among 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25-51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm Minimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.
Sections du résumé
BACKGROUND
BACKGROUND
We conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH).
METHODS
METHODS
We evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months.
RESULTS
RESULTS
Among 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25-51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm
CONCLUSIONS
CONCLUSIONS
Minimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH.
Identifiants
pubmed: 30617144
pii: neurintsurg-2018-014447
doi: 10.1136/neurintsurg-2018-014447
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Pagination
579-583Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: NG, GT, KM, AHK, AP, KA, JJC, AVA, and CN have no financial relationships to disclose. DH is a consultant for Codman, Neurovascular, Medtronic, MicroVention, Penumbra, Sequent, and Stryker. LE is a consultant for Codman Neurovascular, Medtronic, MicroVention, Penumbra, Sequent, and Stryker. DF, is an unpaid consultant and proctor for ev3/Chestnut Medical. ASA is a consultant for Leica, Medtronic, Microvention, Penumbra, Siemens, and Stryker, receives research support from Microvention, Penumbra, and Siemens, and is a shareholder in Bendit, Cerebrotech, Serenity, and Synchron.