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

6 Citations (Scopus)

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

Fingerprint

Minimally Invasive Surgical Procedures
Cerebral Hemorrhage
Tissue Plasminogen Activator
Hematoma
Mortality
Catheters
Intracranial Hemorrhages
Stroke
Hypertension
Education
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

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 journalArticle

Awad, IA, Polster, SP, Carrión-Penagos, J, Thompson, RE, Cao, Y, Stadnik, A, Money, PL, Fam, MD, Koskimäki, J, Girard, R, Lane, K, McBee, N, Ziai, W, Hao, Y, Dodd, R, Carlson, AP, Camarata, PJ, Caron, JL, Harrigan, MR, Gregson, BA, Mendelow, AD, Zuccarello, M, Hanley, DF, Abdul-Rahim, A, Abou-Hamden, A, Abraham, M, Ahmed, A, Alba, CA, Aldrich, EF, Ali, H, Altschul, D, Amin-Hanjani, S, Anderson, CS, Anderson, D, Ansari, S, Antezana, D, Ardelt, A, Arikan, F, Avadhani, R, Baguena, M, Baker, A, Barrer, SJ, Barzo, P, Becker, KJ, Bergman, T, Betz, JF, Bistran-Hall, AJ, Boström, A, Braun, J, Brindley, P, Broaddus, WC, Brown, R, Buki, A, Bulters, D, Cao, B, Carhuapoma, JR, Chalela, J, Chang, T, Chicoine, MR, Chorro, IM, Chowdhry, S, Cobb, C, Corral, L, Csiba, L, Davies, J, Dawson, J, Díaz, AT, Dierdeyn, CP, Diringer, M, Dlugash, R, Ecker, R, Economas, T, Enriquez, P, Ezer, E, Fan, Y, Feng, H, Franz, D, Freeman, WD, Fusco, M, Galicich, W, Gandhi, D, Gelea, ML, Goldstein, J, Gonzalez, AC, Grabarits, C, Greenberg, S, Gress, D, Gu, E, Gupta, G, Hall, C, Harnof, S, Hernandez, FM, Hoesch, R, Hoh, BL, Houser, J, Hu, R, Huang, J, Huang, Y, Hussain, MA, Insinga, S, Jadhav, A, Jaffe, J, Jahromi, BS, Jallo, J, James, M, James, RF, Janis, S, Jankowitz, B, Jeon, E, Jichici, D, Jonczak, K, Jonker, B, Karlen, N, Kase, CS, Keric, N, Kerz, T, Kitagawa, R, Knopman, J, Koenig, C, Krishnamurthy, S, Kumar, A, Kureshi, I, Laidlaw, J, Lakhanpal, A, Latorre, JG, Ledoux, D, Lees, KR, Leifer, D, Leiphart, J, Lenington, S, Li, Y, Lopez, G, Lovick, D, Lumenta, C, Luo, J, Maas, MB, MacDonald, J, MacKenzie, L, Madan, V, Majkowski, R, Major, O, Malhorta, R, Malkoff, M, Mangat, H, Maswadeh, A, Matouk, C, Mayo, SW, McArthur, K, McCaul, S, Medow, J, Mezey, G, Mighty, J, Miller, D, Mitchell, P, Mohan, KK, Mould, WA, Muir, K, Muñoz, L, Nakaji, P, Nee, A, Nekoovaght-Tak, S, Nyquist, P, O'Kane, R, Okasha, M, O'Kelly, C, Ostapkovich, N, Pandey, A, Parry-Jones, A, Patel, H, Perla, KR, Pollack, A, Pouratian, N, Quinn, T, Rajajee, V, Reddy, K, Rehman, M, Reimer, R, Rincon, F, Rosenblum, M, Rybinnik, I, Sanchez, B, Sansing, L, Sarabia, R, Schneck, M, Schuerer, L, Schel, D, Schweitzer, J, Seder, DB, Seyfried, D, Sheth, K, Spiotta, A, Stechison, M, Sugar, EA, Szabo, K, Tamayo, G, Tanczos, K, Taussky, P, Teitelbaum, JS, Terry, J, Testai, F, Thomas, K, Thompson, CB, Thompson, G, Torner, JC, Tran, H, Tucker, K, Ullman, N, Ungar, L, Unterberg, A, Varelas, P, Vargas, NM, Vatter, H, Venkatasubramanian, C, Vermillion, K, Vespa, P, Vollmer, D, Wang, W, Wang, Y, Wang, Y, Wen, J, Whitworth, LT, Willis, B, Wilson, A, Wolfe, S, Wrencher, M, Wright, SE, Xu, Y, Yanase, L, Yenokyan, G, Yi, X, Yu, Z & 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, vol. 84, no. 6, nyz077, pp. 1157-1168. https://doi.org/10.1093/neuros/nyz077
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. / Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure. In: Clinical Neurosurgery. 2019 ; Vol. 84, No. 6. pp. 1157-1168.
@article{d5710474d01141f4a5854260f434cf94,
title = "Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure",
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.",
keywords = "Intracranial hemorrhage, Intraparenchymal hemorrhage, Minimally invasive surgery, MISTIE, Recombinant tissue plasminogen activator",
author = "Awad, {Issam A.} and Polster, {Sean P.} and Juli{\'a}n Carri{\'o}n-Penagos and Thompson, {Richard E.} and Ying Cao and Agnieszka Stadnik and Money, {Patricia Lynn} and Fam, {Maged D.} and Janne Koskim{\"a}ki and Romuald Girard and Karen Lane and Nichol McBee and Wendy Ziai and Yi Hao and Robert Dodd and Carlson, {Andrew P.} and Camarata, {Paul J.} and Caron, {Jean Louis} and Harrigan, {Mark R.} and Gregson, {Barbara A.} and Mendelow, {A. David} and Mario Zuccarello and Hanley, {Daniel F.} and Azmil Abdul-Rahim and Amal Abou-Hamden and Michael Abraham and Azam Ahmed and Alba, {Carlos Alarcon} and Aldrich, {E. Francois} and Hasan Ali and David Altschul and Sepideh Amin-Hanjani and Anderson, {Craig S.} and Doug Anderson and Safdar Ansari and David Antezana and Agnieszka Ardelt and Fuat Arikan and Radhika Avadhani and Marcelino Baguena and Alexandra Baker and Barrer, {Steven J.} and Pal Barzo and Becker, {Kyra J.} and Thomas Bergman and Betz, {Joshua F.} and Bistran-Hall, {Amanda J.} and Azize Bostr{\"o}m and Jamie Braun and Peter Brindley and Broaddus, {William C.} and Robert Brown and Andras Buki and Diederik Bulters and Bing Cao and Carhuapoma, {J. Ricardo} and Julio Chalela and Tiffany Chang and Chicoine, {Michael R.} and Chorro, {Indalecio Moran} and Shakeel Chowdhry and Cully Cobb and Luisa Corral and Laszlo Csiba and Jason Davies and Jesse Dawson and D{\'i}az, {Alberto Torres} and Dierdeyn, {Colin P.} and Michael Diringer and Rachel Dlugash and Robert Ecker and Tracey Economas and Pedro Enriquez and Erzsebet Ezer and Yuhua Fan and Hua Feng and Douglas Franz and Freeman, {W. David} and Matthew Fusco and Walter Galicich and Dheeraj Gandhi and Gelea, {Mary Leigh} and Joshua Goldstein and Gonzalez, {Alejandro Carrasco} and Christina Grabarits and Steven Greenberg and Daryl Gress and Eugene Gu and Gaurav Gupta and Christiana Hall and Sagi Harnof and Hernandez, {Fernando Mu{\~n}oz} and Robert Hoesch and Hoh, {Brian L.} and Jennifer Houser and Rong Hu and Judy Huang and Yi Huang and Hussain, {Mohammed Akbar} and Salvatore Insinga and Ashutosh Jadhav and Jennifer Jaffe and Jahromi, {Babak S.} and Jack Jallo and Michael James and James, {Robert F.} and Scott Janis and Brian Jankowitz and Esther Jeon and Draga Jichici and Karin Jonczak and Ben Jonker and Nicki Karlen and Kase, {Carlos S.} and Naureen Keric and Thomas Kerz and Ryan Kitagawa and Jared Knopman and Carolyn Koenig and Satish Krishnamurthy and Avinash Kumar and Inam Kureshi and John Laidlaw and Arun Lakhanpal and Latorre, {Julius Gene} and David Ledoux and Lees, {Kennedy R.} and Dana Leifer and James Leiphart and Sarah Lenington and Yunke Li and George Lopez and Darren Lovick and Christianto Lumenta and Jinbiao Luo and Maas, {Matthew B.} and Joel MacDonald and Larami MacKenzie and Vikram Madan and Ryan Majkowski and Otto Major and Rishi Malhorta and Marc Malkoff and Halinder Mangat and Ahmed Maswadeh and Charles Matouk and Mayo, {Steven W.} and Kate McArthur and Scott McCaul and Joshua Medow and Geza Mezey and Janet Mighty and David Miller and Patrick Mitchell and Mohan, {Krishna K.} and Mould, {W. Andrew} and Keith Muir and Lorenzo Mu{\~n}oz and Peter Nakaji and Alex Nee and Saman Nekoovaght-Tak and Paul Nyquist and Roddy O'Kane and Mohamed Okasha and Cian O'Kelly and Noeleen Ostapkovich and Aditya Pandey and Adrian Parry-Jones and Hiren Patel and Perla, {Krissia Rivera} and Ania Pollack and Nader Pouratian and Terry Quinn and Ventatakrishna Rajajee and Kesava Reddy and Mohammed Rehman and Ronald Reimer and Fred Rincon and Michael Rosenblum and Igor Rybinnik and Baltasar Sanchez and Lauren Sansing and Rosario Sarabia and Michael Schneck and Ludwig Schuerer and David Schel and Jeffrey Schweitzer and Seder, {David B.} and Donald Seyfried and Kevin Sheth and Alejandro Spiotta and Michael Stechison and Sugar, {Elizabeth A.} and Katalin Szabo and Gonzalo Tamayo and Krisztian Tanczos and Philipp Taussky and Teitelbaum, {Jeanne S.} and John Terry and Fernando Testai and Kathrine Thomas and Thompson, {Carol B.} and Gregory Thompson and Torner, {James C.} and Huy Tran and Kristi Tucker and Natalie Ullman and Lior Ungar and Andreas Unterberg and Panos Varelas and Vargas, {Nataly Montano} and Hartmut Vatter and Chitra Venkatasubramanian and Krista Vermillion and Paul Vespa and Dennis Vollmer and Weimin Wang and Yan Wang and Ying Wang and Jiajun Wen and Whitworth, {Louis Tony} and Byron Willis and Alastair Wilson and Stacey Wolfe and Myriha Wrencher and Wright, {Shawn E.} and Yongge Xu and Lisa Yanase and Gayane Yenokyan and Xuxia Yi and Zhiyuan Yu and Ali Zomorodi",
year = "2019",
month = "6",
day = "1",
doi = "10.1093/neuros/nyz077",
language = "English (US)",
volume = "84",
pages = "1157--1168",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

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

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 - Minimally invasive surgery

KW - MISTIE

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 -