Neurovascular Surgery Program, Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne, UK.
Neurosurgery. 2021 Apr 15;88(5):961-970. doi: 10.1093/neuros/nyaa572.
The extent of intracerebral hemorrhage (ICH) removal conferred survival and functional benefits in the minimally invasive surgery with thrombolysis in intracerebral hemorrhage evacuation (MISTIE) III trial. It is unclear whether this similarly impacts outcome with craniotomy (open surgery) or whether timing from ictus to intervention influences outcome with either procedure.
To compare volume evacuation and timing of surgery in relation to outcomes in the MISTIE III and STICH (Surgical Trial in Intracerebral Hemorrhage) trials.
Postoperative scans were performed in STICH II, but not in STICH I; therefore, surgical MISTIE III cases with lobar hemorrhages (n = 84) were compared to STICH II all lobar cases (n = 259) for volumetric analyses. All MISTIE III surgical patients (n = 240) were compared to both STICH I and II (n = 722) surgical patients for timing analyses. These were investigated using cubic spline modeling and multivariate risk adjustment.
End-of-treatment ICH volume ≤28.8 mL in MISTIE III and ≤30.0 mL in STICH II had increased probability of modified Rankin Scale (mRS) 0 to 3 at 180 d (P = .01 and P = .003, respectively). The effect in the MISTIE cohort remained significant after multivariate risk adjustments. Earlier surgery within 62 h of ictus had a lower probability of achieving an mRS 0 to 3 at 180 d with STICH I and II (P = .0004), but not with MISTIE III. This remained significant with multivariate risk adjustments. There was no impact of timing until intervention on mortality up to 47 h with either procedure.
Thresholds of ICH removal influenced outcome with both procedures to a similar extent. There was a similar likelihood of achieving a good outcome with both procedures within a broad therapeutic time window.
在微创手术与溶栓清除脑出血试验（MISTIE III 试验）中，脑出血（ICH）清除的程度可带来生存和功能获益。目前尚不清楚这种获益是否同样影响开颅术（开放性手术）的结果，或者从发病到干预的时间是否影响两种方法的结果。
比较 MISTIE III 和 STICH（脑出血手术试验）试验中清除血肿量和手术时机与结局的关系。
STICH II 进行了术后扫描，但 STICH I 没有；因此，对 84 例 MISTIE III 手术中幕上出血病例（n=84）与 259 例 STICH II 所有幕上出血病例（n=259）进行了体积分析。对所有 MISTIE III 手术患者（n=240）与 STICH I 和 II（n=722）手术患者进行了手术时机分析。采用三次样条模型和多变量风险调整进行了这些分析。
MISTIE III 中治疗结束时 ICH 体积≤28.8mL 和 STICH II 中 ICH 体积≤30.0mL 的患者在 180d 时改良 Rankin 量表（mRS）评分 0 至 3 的概率增加（P=0.01 和 P=0.003）。在多变量风险调整后，MISTIE 队列的效果仍然显著。STICH I 和 II 中在发病后 62h 内进行更早的手术，在 180d 时达到 mRS 0 至 3 的概率较低（P=0.0004），但 MISTIE III 中并非如此。在多变量风险调整后，这仍然具有显著意义。在两种手术中，直到干预前的时间对 47h 内的死亡率都没有影响。
ICH 清除程度对两种方法的结果均有类似的影响。在广泛的治疗时间窗口内，两种方法都有类似的获得良好结果的可能性。
