Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation.
endoscopic
image-guide
intracerebral hemorrhage
minimally invasive
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
10
10
2019
revised:
08
12
2019
accepted:
09
12
2019
pubmed:
10
1
2020
medline:
8
9
2020
entrez:
10
1
2020
Statut:
ppublish
Résumé
Preclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation. Patients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0-3 at 6 months. One hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0-3 was 46%. This study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Preclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.
METHODS
METHODS
Patients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0-3 at 6 months.
RESULTS
RESULTS
One hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0-3 was 46%.
CONCLUSIONS
CONCLUSIONS
This study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.
Identifiants
pubmed: 31915207
pii: neurintsurg-2019-015528
doi: 10.1136/neurintsurg-2019-015528
pmc: PMC7231458
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
489-494Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: JM receives research funding from Penumbra (manufacturer of the Apollo and Artemis devices) for an ongoing clinical trial evaluating endoscopic ICH evacuation using the Apollo or Artemis devices (INVEST, NCT02654015) and has a financial interest in Rebound Therapeutics now owned by Integra. CPK is site PI of the INVEST and MIND studies funded by Penumbra and site PI for the PILLAR study funded by Minnetronix.
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