Intracerebral Hemorrhage Location Predicts Neurologic Outcome, Mortality, and End-of-Treatment Intracerebral Hemorrhage Volume After Minimally Invasive Evacuation: A Secondary Analysis of MISTIE III. (16th November 2020)

• Record Type: Journal Article
• Authors: Joyce, Evan; Deshmukh, Anish; de Havenon, Adam; Scoville, Jonathan; Ansari, Safdar; Taussky, Philipp; Grandhi, Ramesh
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_257
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Recent trials have shown benefit for minimally invasive clot evacuation of intracerebral hemorrhage (ICH). Subgroup analysis of the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III (MISTIE III) trial found good functional outcome with ICH evacuation to <15mL end-of-treatment (EOT) volume. The influence of ICH location on outcomes amongst surgically treated patients remains unclear. METHODS: We included patients randomized to the surgical arm of the MISTIE III trial. The primary outcome was good outcome (mRS 0–3). Secondary outcomes were death at 1 year and EOT ICH volume <15 mL. The primary predictors were ICH location defined as: basal ganglia or thalamic (deep); frontal; and parietal, occipital, or temporal (POT). RESULTS: 253 surgical patients were grouped based on ICH location with deep, frontal, and POT ICH in 164, 46, and 43 patients, respectively. Mean baseline ICH volume was 47.2, 54.4, and 50.8 mL ( P = . 045) and EOT ICH volume was 14.3, 19.8, and 16.8 mL ( P = . 035) for deep, frontal, and POT ICH locations, respectively. Patients with POT ICH were more likely to achieve good functional outcome compared to deep (OR 4.00; P < . 001) and frontal (OR 7.14; P = . 001) ICH. Patients with frontal ICH were more likely to die (OR 4.58; P = . 035) and less likely to achieve EOT ICH volume < 15 mL (OR 0.25; P = . 009) compared to POT ICH. CONCLUSION: Location of ICH is associated with post-surgical neurologic outcome and ability to achieve satisfactory clot evacuation. This finding may guide prognostication and surgical expectations. Future advances in clot evacuation techniques should address the disparity in ability to achieve complete clot evacuation.