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Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure.

Publication ,  Journal Article
Awad, IA; Polster, SP; Carrión-Penagos, J; Thompson, RE; Cao, Y; Stadnik, A; Money, PL; Fam, MD; Koskimäki, J; Girard, R; Lane, K; McBee, N ...
Published in: Neurosurgery
June 1, 2019

BACKGROUND: 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). OBJECTIVE: To assess surgical performance and its impact on the extent of ICH evacuation and functional outcomes. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

June 1, 2019

Volume

84

Issue

6

Start / End Page

1157 / 1168

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Recovery of Function
  • Neurology & Neurosurgery
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Intracranial Hemorrhages
  • Humans
  • Hematoma
 

Citation

APA
Chicago
ICMJE
MLA
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Awad, I. A., Polster, S. P., Carrión-Penagos, J., Thompson, R. E., Cao, Y., Stadnik, A., … MISTIE III Trial Investigators, . (2019). Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure. Neurosurgery, 84(6), 1157–1168. https://doi.org/10.1093/neuros/nyz077
Awad, Issam A., Sean P. Polster, Julián Carrión-Penagos, Richard E. Thompson, Ying Cao, Agnieszka Stadnik, Patricia Lynn Money, et al. “Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure.Neurosurgery 84, no. 6 (June 1, 2019): 1157–68. https://doi.org/10.1093/neuros/nyz077.
Awad IA, Polster SP, Carrión-Penagos J, Thompson RE, Cao Y, Stadnik A, Money PL, Fam MD, Koskimäki J, Girard R, Lane K, McBee N, Ziai W, Hao Y, Dodd R, Carlson AP, Camarata PJ, Caron J-L, Harrigan MR, Gregson BA, Mendelow AD, Zuccarello M, Hanley DF, MISTIE III Trial Investigators. Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure. Neurosurgery. 2019 Jun 1;84(6):1157–1168.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

June 1, 2019

Volume

84

Issue

6

Start / End Page

1157 / 1168

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Recovery of Function
  • Neurology & Neurosurgery
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Intracranial Hemorrhages
  • Humans
  • Hematoma