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Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation ( MISTIE ) clinical trial . INTRODUCTION Compared to ischemic stroke , intracerebral hemorrhage ( ICH ) is easily and rapidly identified , occurs in younger patients , and produces relatively small initial injury to cerebral tissues -- all factors suggesting that interventional amelioration is possible . Investigations from the last decade established that extent of ICH-mediated brain injury relates directly to blood clot volume and duration of blood exposure to brain tissue . Using minimally-invasive surgery plus recombinant tissue plasminogen activator ( rtPA ) , MISTIE investigators explored aggressive avenues to treat ICH . METHODS We investigated the difference between surgical intervention plus rtPA and standard medical management for ICH . Subjects in both groups were medically managed according to standard ICU protocols . Subjects randomized to surgery underwent stereotactic catheter placement and clot aspiration . Injections of rtPA were then given through hematoma catheter every 8 h , up to 9 doses , or until a clot-reduction endpoint . After each injection the system was flushed with sterile saline and closed for 60 min before opening to spontaneous drainage . RESULTS Average aspiration of clots for all patients randomized to surgery plus rtPA was 20 % of mean initial clot size . After acute treatment phase ( aspiration plus rtPA ) , clot was reduced an average of 46 % . Recorded adverse events were within safety limits , including 30-day mortality , 8 % ; symptomatic re-bleeding , 8 % ; and bacterial ventriculitis , 0 % . Patients randomized to medical management showed 4 % clot resolution in a similar time window . Preliminary analysis indicates that clot resolution rates are greatly dependent on catheter placement . Location of ICH also affects efficacy of aggressive treatment of ICH . CONCLUSION There is tentative indication that minimally-invasive surgery plus rtPA shows greater clot resolution than traditional medical management .
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Intervention_Surgical
minimally-invasive surgery plus rtPA
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Intervention_Surgical
minimally-invasive surgery plus recombinant tissue plasminogen activator ( rtPA )
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Intervention_Surgical
surgical intervention plus rtPA
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Intervention_Pharmacological
standard medical management for
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Intervention_Surgical
stereotactic catheter placement and clot aspiration
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Intervention_Pharmacological
Injections of rtPA
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Intervention_Pharmacological
sterile saline
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Outcome_Physical
intracerebral hemorrhage evacuation
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Outcome_Physical
Average aspiration of clots
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Outcome_Physical
clot
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Outcome_Mortality
30-day mortality
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Outcome_Physical
symptomatic re-bleeding
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Outcome_Physical
bacterial ventriculitis
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Outcome_Physical
clot resolution
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Outcome_Physical
clot resolution rates
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Outcome_Physical
greater clot resolution
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Participant_Condition
intracerebral hemorrhage
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Participant_Age
younger
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Participant_Sample-size
groups
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Participant_Condition
medically managed according to standard ICU protocols .