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

Issam A. Awad, Sean P. Polster, Julián Carrión-Penagos, Richard E. Thompson, Ying Cao, Agnieszka Stadnik, Patricia Lynn Money, Maged D. Fam, Janne Koskimäki, Romuald Girard, Karen Lane, Nichol McBee, Wendy Ziai, Yi Hao, Robert Dodd, Andrew P. Carlson, Paul J. Camarata, Jean Louis Caron, Mark R. Harrigan, Barbara A. GregsonA. David Mendelow, Mario Zuccarello, Daniel F. Hanley, Azmil Abdul-Rahim, Amal Abou-Hamden, Michael Abraham, Azam Ahmed, Carlos Alarcon Alba, E. Francois Aldrich, Hasan Ali, David Altschul, Sepideh Amin-Hanjani, Craig S. Anderson, Doug Anderson, Safdar Ansari, David Antezana, Agnieszka Ardelt, Fuat Arikan, Radhika Avadhani, Marcelino Baguena, Alexandra Baker, Steven J. Barrer, Pal Barzo, Kyra J. Becker, Thomas Bergman, Joshua F. Betz, Amanda J. Bistran-Hall, Azize Boström, Jamie Braun, Peter Brindley, William C. Broaddus, Robert Brown, Andras Buki, Diederik Bulters, Bing Cao, J. Ricardo Carhuapoma, Julio Chalela, Tiffany Chang, Michael R. Chicoine, Indalecio Moran Chorro, Shakeel Chowdhry, Cully Cobb, Luisa Corral, Laszlo Csiba, Jason Davies, Jesse Dawson, Alberto Torres Díaz, Colin P. Dierdeyn, Michael Diringer, Rachel Dlugash, Robert Ecker, Tracey Economas, Pedro Enriquez, Erzsebet Ezer, Yuhua Fan, Hua Feng, Douglas Franz, W. David Freeman, Matthew Fusco, Walter Galicich, Dheeraj Gandhi, Mary Leigh Gelea, Joshua Goldstein, Alejandro Carrasco Gonzalez, Christina Grabarits, Steven Greenberg, Daryl Gress, Eugene Gu, Gaurav Gupta, Christiana Hall, Sagi Harnof, Fernando Muñoz Hernandez, Robert Hoesch, Brian L. Hoh, Jennifer Houser, Rong Hu, Judy Huang, Yi Huang, Mohammed Akbar Hussain, Salvatore Insinga, Ashutosh Jadhav, Jennifer Jaffe, Babak S. Jahromi, Jack Jallo, Michael James, Robert F. James, Scott Janis, Brian Jankowitz, Esther Jeon, Draga Jichici, Karin Jonczak, Ben Jonker, Nicki Karlen, Carlos S. Kase, Naureen Keric, Thomas Kerz, Ryan Kitagawa, Jared Knopman, Carolyn Koenig, Satish Krishnamurthy, Avinash Kumar, Inam Kureshi, John Laidlaw, Arun Lakhanpal, Julius Gene Latorre, David Ledoux, Kennedy R. Lees, Dana Leifer, James Leiphart, Sarah Lenington, Yunke Li, George Lopez, Darren Lovick, Christianto Lumenta, Jinbiao Luo, Matthew B. Maas, Joel MacDonald, Larami MacKenzie, Vikram Madan, Ryan Majkowski, Otto Major, Rishi Malhorta, Marc Malkoff, Halinder Mangat, Ahmed Maswadeh, Charles Matouk, Steven W. Mayo, Kate McArthur, Scott McCaul, Joshua Medow, Geza Mezey, Janet Mighty, David Miller, Patrick Mitchell, Krishna K. Mohan, W. Andrew Mould, Keith Muir, Lorenzo Muñoz, Peter Nakaji, Alex Nee, Saman Nekoovaght-Tak, Paul Nyquist, Roddy O'Kane, Mohamed Okasha, Cian O'Kelly, Noeleen Ostapkovich, Aditya Pandey, Adrian Parry-Jones, Hiren Patel, Krissia Rivera Perla, Ania Pollack, Nader Pouratian, Terry Quinn, Ventatakrishna Rajajee, Kesava Reddy, Mohammed Rehman, Ronald Reimer, Fred Rincon, Michael Rosenblum, Igor Rybinnik, Baltasar Sanchez, Lauren Sansing, Rosario Sarabia, Michael Schneck, Ludwig Schuerer, David Schel, Jeffrey Schweitzer, David B. Seder, Donald Seyfried, Kevin Sheth, Alejandro Spiotta, Michael Stechison, Elizabeth A. Sugar, Katalin Szabo, Gonzalo Tamayo, Krisztian Tanczos, Philipp Taussky, Jeanne S. Teitelbaum, John Terry, Fernando Testai, Kathrine Thomas, Carol B. Thompson, Gregory Thompson, James C. Torner, Huy Tran, Kristi Tucker, Natalie Ullman, Lior Ungar, Andreas Unterberg, Panos Varelas, Nataly Montano Vargas, Hartmut Vatter, Chitra Venkatasubramanian, Krista Vermillion, Paul Vespa, Dennis Vollmer, Weimin Wang, Yan Wang, Ying Wang, Jiajun Wen, Louis Tony Whitworth, Byron Willis, Alastair Wilson, Stacey Wolfe, Myriha Wrencher, Shawn E. Wright, Yongge Xu, Lisa Yanase, Gayane Yenokyan, Xuxia Yi, Zhiyuan Yu, Ali Zomorodi

Research output: Contribution to journalArticle

7 Scopus citations

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 languageEnglish (US)
Article numbernyz077
Pages (from-to)1157-1168
Number of pages12
JournalClinical Neurosurgery
Volume84
Issue number6
DOIs
StatePublished - Jun 1 2019

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Keywords

  • Intracranial hemorrhage
  • Intraparenchymal hemorrhage
  • MISTIE
  • Minimally invasive surgery
  • Recombinant tissue plasminogen activator

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Awad, I. A., Polster, S. P., Carrión-Penagos, J., Thompson, R. E., Cao, Y., Stadnik, A., Money, P. L., Fam, M. D., Koskimäki, J., Girard, R., Lane, K., McBee, N., Ziai, W., Hao, Y., Dodd, R., Carlson, A. P., Camarata, P. J., Caron, J. L., Harrigan, M. R., ... Zomorodi, A. (2019). Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure. Clinical Neurosurgery, 84(6), 1157-1168. [nyz077]. https://doi.org/10.1093/neuros/nyz077