Abstract
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.
| Original language | English (US) |
|---|---|
| Article number | nyz077 |
| Pages (from-to) | 1157-1168 |
| Number of pages | 12 |
| Journal | Clinical Neurosurgery |
| Volume | 84 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2019 |
Keywords
- Intracranial hemorrhage
- Intraparenchymal hemorrhage
- MISTIE
- Minimally invasive surgery
- Recombinant tissue plasminogen activator
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
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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. / Awad, Issam A.; Polster, Sean P.; Carrión-Penagos, Julián; Thompson, Richard E.; Cao, Ying; Stadnik, Agnieszka; Money, Patricia Lynn; Fam, Maged D.; Koskimäki, Janne; Girard, Romuald; Lane, Karen; McBee, Nichol; Ziai, Wendy; Hao, Yi; Dodd, Robert; Carlson, Andrew P.; Camarata, Paul J.; Caron, Jean Louis; Harrigan, Mark R.; Gregson, Barbara A.; Mendelow, A. David; Zuccarello, Mario; Hanley, Daniel F.; Abdul-Rahim, Azmil; Abou-Hamden, Amal; Abraham, Michael; Ahmed, Azam; Alba, Carlos Alarcon; Aldrich, E. Francois; Ali, Hasan; Altschul, David; Amin-Hanjani, Sepideh; Anderson, Craig S.; Anderson, Doug; Ansari, Safdar; Antezana, David; Ardelt, Agnieszka; Arikan, Fuat; Avadhani, Radhika; Baguena, Marcelino; Baker, Alexandra; Barrer, Steven J.; Barzo, Pal; Becker, Kyra J.; Bergman, Thomas; Betz, Joshua F.; Bistran-Hall, Amanda J.; Boström, Azize; Braun, Jamie; Brindley, Peter; Broaddus, William C.; Brown, Robert; Buki, Andras; Bulters, Diederik; Cao, Bing; Carhuapoma, J. Ricardo; Chalela, Julio; Chang, Tiffany; Chicoine, Michael R.; Chorro, Indalecio Moran; Chowdhry, Shakeel; Cobb, Cully; Corral, Luisa; Csiba, Laszlo; Davies, Jason; Dawson, Jesse; Díaz, Alberto Torres; Dierdeyn, Colin P.; Diringer, Michael; Dlugash, Rachel; Ecker, Robert; Economas, Tracey; Enriquez, Pedro; Ezer, Erzsebet; Fan, Yuhua; Feng, Hua; Franz, Douglas; Freeman, W. David; Fusco, Matthew; Galicich, Walter; Gandhi, Dheeraj; Gelea, Mary Leigh; Goldstein, Joshua; Gonzalez, Alejandro Carrasco; Grabarits, Christina; Greenberg, Steven; Gress, Daryl; Gu, Eugene; Gupta, Gaurav; Hall, Christiana; Harnof, Sagi; Hernandez, Fernando Muñoz; Hoesch, Robert; Hoh, Brian L.; Houser, Jennifer; Hu, Rong; Huang, Judy; Huang, Yi; Hussain, Mohammed Akbar; Insinga, Salvatore; Jadhav, Ashutosh; Jaffe, Jennifer; Jahromi, Babak S.; Jallo, Jack; James, Michael; James, Robert F.; Janis, Scott; Jankowitz, Brian; Jeon, Esther; Jichici, Draga; Jonczak, Karin; Jonker, Ben; Karlen, Nicki; Kase, Carlos S.; Keric, Naureen; Kerz, Thomas; Kitagawa, Ryan; Knopman, Jared; Koenig, Carolyn; Krishnamurthy, Satish; Kumar, Avinash; Kureshi, Inam; Laidlaw, John; Lakhanpal, Arun; Latorre, Julius Gene; Ledoux, David; Lees, Kennedy R.; Leifer, Dana; Leiphart, James; Lenington, Sarah; Li, Yunke; Lopez, George; Lovick, Darren; Lumenta, Christianto; Luo, Jinbiao; Maas, Matthew B.; MacDonald, Joel; MacKenzie, Larami; Madan, Vikram; Majkowski, Ryan; Major, Otto; Malhorta, Rishi; Malkoff, Marc; Mangat, Halinder; Maswadeh, Ahmed; Matouk, Charles; Mayo, Steven W.; McArthur, Kate; McCaul, Scott; Medow, Joshua; Mezey, Geza; Mighty, Janet; Miller, David; Mitchell, Patrick; Mohan, Krishna K.; Mould, W. Andrew; Muir, Keith; Muñoz, Lorenzo; Nakaji, Peter; Nee, Alex; Nekoovaght-Tak, Saman; Nyquist, Paul; O'Kane, Roddy; Okasha, Mohamed; O'Kelly, Cian; Ostapkovich, Noeleen; Pandey, Aditya; Parry-Jones, Adrian; Patel, Hiren; Perla, Krissia Rivera; Pollack, Ania; Pouratian, Nader; Quinn, Terry; Rajajee, Ventatakrishna; Reddy, Kesava; Rehman, Mohammed; Reimer, Ronald; Rincon, Fred; Rosenblum, Michael; Rybinnik, Igor; Sanchez, Baltasar; Sansing, Lauren; Sarabia, Rosario; Schneck, Michael; Schuerer, Ludwig; Schel, David; Schweitzer, Jeffrey; Seder, David B.; Seyfried, Donald; Sheth, Kevin; Spiotta, Alejandro; Stechison, Michael; Sugar, Elizabeth A.; Szabo, Katalin; Tamayo, Gonzalo; Tanczos, Krisztian; Taussky, Philipp; Teitelbaum, Jeanne S.; Terry, John; Testai, Fernando; Thomas, Kathrine; Thompson, Carol B.; Thompson, Gregory; Torner, James C.; Tran, Huy; Tucker, Kristi; Ullman, Natalie; Ungar, Lior; Unterberg, Andreas; Varelas, Panos; Vargas, Nataly Montano; Vatter, Hartmut; Venkatasubramanian, Chitra; Vermillion, Krista; Vespa, Paul; Vollmer, Dennis; Wang, Weimin; Wang, Yan; Wang, Ying; Wen, Jiajun; Whitworth, Louis Tony; Willis, Byron; Wilson, Alastair; Wolfe, Stacey; Wrencher, Myriha; Wright, Shawn E.; Xu, Yongge; Yanase, Lisa; Yenokyan, Gayane; Yi, Xuxia; Yu, Zhiyuan; Zomorodi, Ali.
In: Clinical Neurosurgery, Vol. 84, No. 6, nyz077, 01.06.2019, p. 1157-1168.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure
AU - Awad, Issam A.
AU - Polster, Sean P.
AU - Carrión-Penagos, Julián
AU - Thompson, Richard E.
AU - Cao, Ying
AU - Stadnik, Agnieszka
AU - Money, Patricia Lynn
AU - Fam, Maged D.
AU - Koskimäki, Janne
AU - Girard, Romuald
AU - Lane, Karen
AU - McBee, Nichol
AU - Ziai, Wendy
AU - Hao, Yi
AU - Dodd, Robert
AU - Carlson, Andrew P.
AU - Camarata, Paul J.
AU - Caron, Jean Louis
AU - Harrigan, Mark R.
AU - Gregson, Barbara A.
AU - Mendelow, A. David
AU - Zuccarello, Mario
AU - Hanley, Daniel F.
AU - Abdul-Rahim, Azmil
AU - Abou-Hamden, Amal
AU - Abraham, Michael
AU - Ahmed, Azam
AU - Alba, Carlos Alarcon
AU - Aldrich, E. Francois
AU - Ali, Hasan
AU - Altschul, David
AU - Amin-Hanjani, Sepideh
AU - Anderson, Craig S.
AU - Anderson, Doug
AU - Ansari, Safdar
AU - Antezana, David
AU - Ardelt, Agnieszka
AU - Arikan, Fuat
AU - Avadhani, Radhika
AU - Baguena, Marcelino
AU - Baker, Alexandra
AU - Barrer, Steven J.
AU - Barzo, Pal
AU - Becker, Kyra J.
AU - Bergman, Thomas
AU - Betz, Joshua F.
AU - Bistran-Hall, Amanda J.
AU - Boström, Azize
AU - Braun, Jamie
AU - Brindley, Peter
AU - Broaddus, William C.
AU - Brown, Robert
AU - Buki, Andras
AU - Bulters, Diederik
AU - Cao, Bing
AU - Carhuapoma, J. Ricardo
AU - Chalela, Julio
AU - Chang, Tiffany
AU - Chicoine, Michael R.
AU - Chorro, Indalecio Moran
AU - Chowdhry, Shakeel
AU - Cobb, Cully
AU - Corral, Luisa
AU - Csiba, Laszlo
AU - Davies, Jason
AU - Dawson, Jesse
AU - Díaz, Alberto Torres
AU - Dierdeyn, Colin P.
AU - Diringer, Michael
AU - Dlugash, Rachel
AU - Ecker, Robert
AU - Economas, Tracey
AU - Enriquez, Pedro
AU - Ezer, Erzsebet
AU - Fan, Yuhua
AU - Feng, Hua
AU - Franz, Douglas
AU - Freeman, W. David
AU - Fusco, Matthew
AU - Galicich, Walter
AU - Gandhi, Dheeraj
AU - Gelea, Mary Leigh
AU - Goldstein, Joshua
AU - Gonzalez, Alejandro Carrasco
AU - Grabarits, Christina
AU - Greenberg, Steven
AU - Gress, Daryl
AU - Gu, Eugene
AU - Gupta, Gaurav
AU - Hall, Christiana
AU - Harnof, Sagi
AU - Hernandez, Fernando Muñoz
AU - Hoesch, Robert
AU - Hoh, Brian L.
AU - Houser, Jennifer
AU - Hu, Rong
AU - Huang, Judy
AU - Huang, Yi
AU - Hussain, Mohammed Akbar
AU - Insinga, Salvatore
AU - Jadhav, Ashutosh
AU - Jaffe, Jennifer
AU - Jahromi, Babak S.
AU - Jallo, Jack
AU - James, Michael
AU - James, Robert F.
AU - Janis, Scott
AU - Jankowitz, Brian
AU - Jeon, Esther
AU - Jichici, Draga
AU - Jonczak, Karin
AU - Jonker, Ben
AU - Karlen, Nicki
AU - Kase, Carlos S.
AU - Keric, Naureen
AU - Kerz, Thomas
AU - Kitagawa, Ryan
AU - Knopman, Jared
AU - Koenig, Carolyn
AU - Krishnamurthy, Satish
AU - Kumar, Avinash
AU - Kureshi, Inam
AU - Laidlaw, John
AU - Lakhanpal, Arun
AU - Latorre, Julius Gene
AU - Ledoux, David
AU - Lees, Kennedy R.
AU - Leifer, Dana
AU - Leiphart, James
AU - Lenington, Sarah
AU - Li, Yunke
AU - Lopez, George
AU - Lovick, Darren
AU - Lumenta, Christianto
AU - Luo, Jinbiao
AU - Maas, Matthew B.
AU - MacDonald, Joel
AU - MacKenzie, Larami
AU - Madan, Vikram
AU - Majkowski, Ryan
AU - Major, Otto
AU - Malhorta, Rishi
AU - Malkoff, Marc
AU - Mangat, Halinder
AU - Maswadeh, Ahmed
AU - Matouk, Charles
AU - Mayo, Steven W.
AU - McArthur, Kate
AU - McCaul, Scott
AU - Medow, Joshua
AU - Mezey, Geza
AU - Mighty, Janet
AU - Miller, David
AU - Mitchell, Patrick
AU - Mohan, Krishna K.
AU - Mould, W. Andrew
AU - Muir, Keith
AU - Muñoz, Lorenzo
AU - Nakaji, Peter
AU - Nee, Alex
AU - Nekoovaght-Tak, Saman
AU - Nyquist, Paul
AU - O'Kane, Roddy
AU - Okasha, Mohamed
AU - O'Kelly, Cian
AU - Ostapkovich, Noeleen
AU - Pandey, Aditya
AU - Parry-Jones, Adrian
AU - Patel, Hiren
AU - Perla, Krissia Rivera
AU - Pollack, Ania
AU - Pouratian, Nader
AU - Quinn, Terry
AU - Rajajee, Ventatakrishna
AU - Reddy, Kesava
AU - Rehman, Mohammed
AU - Reimer, Ronald
AU - Rincon, Fred
AU - Rosenblum, Michael
AU - Rybinnik, Igor
AU - Sanchez, Baltasar
AU - Sansing, Lauren
AU - Sarabia, Rosario
AU - Schneck, Michael
AU - Schuerer, Ludwig
AU - Schel, David
AU - Schweitzer, Jeffrey
AU - Seder, David B.
AU - Seyfried, Donald
AU - Sheth, Kevin
AU - Spiotta, Alejandro
AU - Stechison, Michael
AU - Sugar, Elizabeth A.
AU - Szabo, Katalin
AU - Tamayo, Gonzalo
AU - Tanczos, Krisztian
AU - Taussky, Philipp
AU - Teitelbaum, Jeanne S.
AU - Terry, John
AU - Testai, Fernando
AU - Thomas, Kathrine
AU - Thompson, Carol B.
AU - Thompson, Gregory
AU - Torner, James C.
AU - Tran, Huy
AU - Tucker, Kristi
AU - Ullman, Natalie
AU - Ungar, Lior
AU - Unterberg, Andreas
AU - Varelas, Panos
AU - Vargas, Nataly Montano
AU - Vatter, Hartmut
AU - Venkatasubramanian, Chitra
AU - Vermillion, Krista
AU - Vespa, Paul
AU - Vollmer, Dennis
AU - Wang, Weimin
AU - Wang, Yan
AU - Wang, Ying
AU - Wen, Jiajun
AU - Whitworth, Louis Tony
AU - Willis, Byron
AU - Wilson, Alastair
AU - Wolfe, Stacey
AU - Wrencher, Myriha
AU - Wright, Shawn E.
AU - Xu, Yongge
AU - Yanase, Lisa
AU - Yenokyan, Gayane
AU - Yi, Xuxia
AU - Yu, Zhiyuan
AU - Zomorodi, Ali
N1 - Publisher Copyright: © 2019 by the Congress of Neurological Surgeons.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
KW - Intracranial hemorrhage
KW - Intraparenchymal hemorrhage
KW - MISTIE
KW - Minimally invasive surgery
KW - Recombinant tissue plasminogen activator
UR - http://www.scopus.com/inward/record.url?scp=85066457671&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066457671&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyz077
DO - 10.1093/neuros/nyz077
M3 - Article
C2 - 30891610
AN - SCOPUS:85066457671
VL - 84
SP - 1157
EP - 1168
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
M1 - nyz077
ER -