1. Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage.
- Author
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Li Y, Cho SM, Avadhani R, Ali H, Hao Y, Murthy SB, Goldstein JN, Xia F, Hu X, Ullman NL, Awad I, Hanley D, and Ziai WC
- Subjects
- Humans, Male, Female, Treatment Outcome, Aged, Middle Aged, Time Factors, Risk Factors, Tissue Plasminogen Activator administration & dosage, Tissue Plasminogen Activator adverse effects, Recovery of Function, Minimally Invasive Surgical Procedures, Thrombolytic Therapy adverse effects, Neurosurgical Procedures adverse effects, Risk Assessment, Cerebral Small Vessel Diseases diagnostic imaging, Cerebral Small Vessel Diseases surgery, Cerebral Small Vessel Diseases physiopathology, Cerebral Hemorrhage surgery, Cerebral Hemorrhage diagnostic imaging, Magnetic Resonance Imaging, Predictive Value of Tests, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Functional Status
- Abstract
Background: Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes., Methods: Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial's primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models., Results: Of 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30-53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all P
interaction >0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05-0.42); Pinteraction =0.006), absence of lacunes (OR, 0.37 (0.18-0.80); Pinteraction =0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08-0.58); Pinteraction =0.03)., Conclusions: Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2024
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