Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure
Rattachement africain : us, gb. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
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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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure
- Date Crossref
- 20/03/2019
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Johns Hopkins University Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
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University of Kansas Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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University of New Mexico Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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University of Alabama at Birmingham Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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University of Chicago Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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The University of Texas at San Antonio Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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University of Cincinnati Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Newcastle University Neurosurgical Trials Group pays non établi dans la noticeUniversité ou école supérieure
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University of Cincinnati Medical Center pays non établi dans la noticeÉtablissement de santé
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Stanford University Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
Department of Neurology — Johns Hopkins University, Department of Neurosurgery — University of Kansas et Department of Neurosurgery — University of New Mexico, avec 7 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.