Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

Nitin Goyal, Georgios Tsivgoulis, Konark Malhotra, Aristeidis H. Katsanos, Abhi Pandhi, Khalid Alsherbini, Jason J. Chang, Daniel Hoit, Andrei Alexandrov, Lucas Elijovich, David Fiorella, Christopher Nickele, Adam Arthur

Research output: Contribution to journalArticle

Abstract

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 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 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 3 (IQR, 25-50) vs 15 cm 3 (IQR, 5-20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041). 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.

Original languageEnglish (US)
Pages (from-to)579-583
Number of pages5
JournalJournal of neurointerventional surgery
Volume11
Issue number6
DOIs
StatePublished - Jun 1 2019

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Basal Ganglia Hemorrhage
Cerebral Hemorrhage
Hematoma
Minimally Invasive Surgical Procedures
Hospital Mortality
Propensity Score
National Institutes of Health (U.S.)
Stroke Volume
Case-Control Studies
Randomized Controlled Trials
Stroke
Outcome Assessment (Health Care)
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage. / Goyal, Nitin; Tsivgoulis, Georgios; Malhotra, Konark; Katsanos, Aristeidis H.; Pandhi, Abhi; Alsherbini, Khalid; Chang, Jason J.; Hoit, Daniel; Alexandrov, Andrei; Elijovich, Lucas; Fiorella, David; Nickele, Christopher; Arthur, Adam.

In: Journal of neurointerventional surgery, Vol. 11, No. 6, 01.06.2019, p. 579-583.

Research output: Contribution to journalArticle

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abstract = "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 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 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 3 (IQR, 25-50) vs 15 cm 3 (IQR, 5-20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28{\%} vs 56{\%}; P=0.041). 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.",
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T1 - Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Malhotra, Konark

AU - Katsanos, Aristeidis H.

AU - Pandhi, Abhi

AU - Alsherbini, Khalid

AU - Chang, Jason J.

AU - Hoit, Daniel

AU - Alexandrov, Andrei

AU - Elijovich, Lucas

AU - Fiorella, David

AU - Nickele, Christopher

AU - Arthur, Adam

PY - 2019/6/1

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N2 - 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 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 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 3 (IQR, 25-50) vs 15 cm 3 (IQR, 5-20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041). 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.

AB - 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 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 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 3 (IQR, 25-50) vs 15 cm 3 (IQR, 5-20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041). 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.

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U2 - 10.1136/neurintsurg-2018-014447

DO - 10.1136/neurintsurg-2018-014447

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JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

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