Association of Serum IL-6 (Interleukin 6) With Functional Outcome After Intracerebral Hemorrhage

Background and Objectives: IL-6 (interleukin 6) is a proinflammatory cytokine and an established biomarker in acute brain injury. We sought to determine whether admission IL-6 levels are associated with severity and functional outcome after spontaneous intracerebral hemorrhage (ICH). Methods: We performed an exploratory analysis of the recombinant activated FAST trial (Factor VII for Acute ICH). Patients with admission serum IL-6 levels were included. Regression analyses were used to assess the associations between IL-6 and 90-day modified Rankin Scale. In secondary analyses, we used linear regression to evaluate the association between IL-6 and baseline ICH and perihematomal edema volumes. Results: Of 841 enrolled patients, we included 552 (66%) with available admission IL-6 levels (mean age 64 [SD 13], female sex 203 [37%]). IL-6 was associated with poor outcome (modified Rankin Scale, 4–6; per additional 1 ng/L, odds ratio, 1.30 [95% CI, 1.04–1.63]; P =0.02) after adjustment for known predictors of outcome after ICH and treatment group. IL-6 was associated with ICH volume after adjustment for age, sex, and ICH location, and this association was modified by location (multivariable interaction, P =0.002), with a stronger association seen in lobar (β, 12.51 [95% CI, 6.47–18.55], P <0.001) versus nonlobar (β 5.32 [95% CI, 3.36–7.28], P <0.001) location. IL-6 was associated with perihematomal edema volume after adjustment for age, sex, ICH volume, and ICH location (β 1.22 [95% CI, 0.15–2.29], P =0.03). Treatment group was not associated with IL-6 levels or outcome. Conclusions: In the FAST trial population, higher admission IL-6 levels were associated with worse 90-day functional outcome and larger ICH and perihematomal edema volumes.

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POST-NOAC: Portuguese observational study of intracranial hemorrhage on non-vitamin K antagonist oral anticoagulants

International Journal of Stroke ◽

10.1177/1747493016681021 ◽

2016 ◽

Vol 12 (6) ◽

pp. 623-627 ◽

Cited By ~ 11

Author(s):

Cláudia Marques-Matos ◽

José Nuno Alves ◽

João Pedro Marto ◽

Joana Afonso Ribeiro ◽

Ana Monteiro ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Intracranial Hemorrhage ◽

Vitamin K ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Vitamin K Antagonist ◽

Significant Shift ◽

Modified Rankin Scale

Background There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. Aims To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. Methods We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals. Clinical and demographic data were obtained from individual medical records. Intracranial hemorrhage was classified as intracerebral, extra-axial, or multifocal using brain computed tomography. Three-month functional outcome was assessed using the modified Rankin Scale. Results Among 246 patients included, 24 (9.8%) were anticoagulated with a non-vitamin K antagonist oral anticoagulants and 222 (90.2%) with a vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants patients were older (81.5 vs. 76 years, p = 0.048) and had intracerebral hemorrhage more often (83.3% vs. 63.1%, p = 0.048). We detected a non-significant trend for larger intracerebral hemorrhage volumes in vitamin K antagonists patients ( p = 0.368). Survival analysis adjusted for age, CHA2DS2VASc, HAS-BLED, and anticoagulation reversal revealed that non-vitamin K antagonist oral anticoagulants did not influence three-month mortality (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.39–1.80, p = 0.638). Multivariable ordinal regression for three-month functional outcome did not show a significant shift of modified Rankin Scale scores in non-vitamin K antagonist oral anticoagulants patients (odds ratio (OR) 1.26, 95%CI 0.55–2.87, p = 0.585). Conclusions We detected no significant differences in the three-month outcome between non-vitamin K antagonist oral anticoagulants- and vitamin K antagonists-associated intracranial hemorrhage, despite unavailability of non-vitamin K antagonist oral anticoagulants-specific reversal agents.

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Predictors of surgical outcome among patients with spontaneous supratentorial intracerebral hemorrhage: A prospective single institutional study

Nepal Journal of Neuroscience ◽

10.3126/njn.v18i2.33963 ◽

2021 ◽

Vol 18 (2) ◽

pp. 23-29

Author(s):

Somraj Lamichhane ◽

Ruchi Devbhandari ◽

Sabin Tripathee ◽

Manisha Chapagain

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Decompressive Craniectomy ◽

Young Patients ◽

Functional Independence ◽

Modified Rankin Scale ◽

Dominant Hemisphere ◽

Co Morbidity ◽

Surgical Evacuation

Introduction: Intracerebral hemorrhage (ICH) is a potentially devastating neurologic emergency with long-term functional independence achieved in only limited patients with good prognostic factors. The objective of this study is toidentify the predictors of functional outcome in terms of modified Rankin Scale (mRS) following craniotomy and evacuation of spontaneous supratentorial ICH. Methodology: It is a prospective study of forty patients conducted at the College of Medical Sciences (CMS) from May 2019 to April 2020 with three months follow-up. Patients of spontaneous supratentorial ICH with features of raised ICP and deteriorating GCS underwent surgical evacuation. The various predictors of outcome like Glasgow Coma Score (GCS) and pupillary inequality at presentation, age, location of hematoma, clot volume, comorbidities, intra-ventricular extension and involvement of dominant hemisphere were documented and compared with outcome in terms of modified Rankin Scale (mRS). Results: The mortality rate at three months was 25% (32% in deep seated and 13.3% in lobar ICH) and higher in patients with poor GCS and pupillary inequality at presentation, volume >100 ml, intra-ventricular extension and patients undergoing decompressive craniectomy. Twenty patients (50%) had a favorable outcome (mRS 1-3) at follow-up, while 20 (50%) had a poor outcome (mRS 4-6). Unfavorable outcome was significantly higher among deep seated hematoma, age>70 years, poor GCS and pupillary inequality at presentation, clot volume >100ml, pre-existing co-morbidity, patients undergoing decompressive craniectomy and involvement of dominant hemisphere. Conclusion: Surgical evacuation of spontaneous supratentorial ICH is associated with high mortality in patients with poor GCS and pupillary inequality at presentation, and large clot volume with intraventricular extension. However, young patients with good pre-morbid status, moderate volume of hematoma, not involving dominant hemisphere and moderate to good GCS have good functional outcome.

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Fibrinolytic for treatment of intraventricular hemorrhage: A meta-analysis and systematic review

International Journal of Stroke ◽

10.1177/1747493017730745 ◽

2017 ◽

Vol 13 (1) ◽

pp. 11-23 ◽

Cited By ~ 8

Author(s):

Alexandra Delaney Baker ◽

Krissia Margarita Rivera Perla ◽

Zhiyuan Yu ◽

Rachel Dlugash ◽

Radhika Avadhani ◽

...

Keyword(s):

Treatment Group ◽

Functional Outcome ◽

Scale Score ◽

Glasgow Outcome Scale ◽

Functional Outcomes ◽

Intraventricular Hemorrhage ◽

Meta Analysis ◽

Effect Sizes ◽

Modified Rankin Scale ◽

Mortality And Morbidity

Background Intraventricular hemorrhage is a significant cause of mortality and morbidity worldwide. Treating intraventricular hemorrhage with intraventricular fibrinolytic therapy via a catheter is becoming an increasingly utilized intervention. Aims This meta-analysis aimed to investigate the role of intraventricular fibrinolytic treatment in hypertensive intraventricular hemorrhage patients and evaluate the effect sizes for survival as well as level of function at differing time points. Summary of review PubMed, CNKI, VIP, and Wanfang were searched using the terms “IVH” and “IVH and ICH” for human studies with adult patients published between January 1950 and July 2016. Seventeen publications were selected. Data analysis showed lower rates of mortality in the treatment group at 30 days ( P < 0.001), 180 days ( P = 0.001), 365 days ( P = 0.40), and overall ( P < 0.001). Pooling modified Rankin Scale and Glasgow outcome scale data, the treatment group had more good functional outcomes at 30 days ( P = 0.38), 90 days ( P = 0.04), 180 days ( P = 0.31), 365 days ( P = 0.76), and overall ( P = 0.02). Good functional outcome was defined as modified Rankin Scale score of 0 to 3 or a Glasgow outcome scale score of 3 to 5. Conclusions Intraventricular fibrinolytic for treatment of hypertensive intraventricular hemorrhage reduces mortality and potentially leads to an increased number of good functional outcomes. Different functional outcome scales (modified Rankin Scale or Glasgow outcome scale) produce different effect sizes. Intraventricular fibrinolytic treatment may offer intraventricular hemorrhage patients a targeted therapy that produces meaningful mortality benefit and possible functional outcome benefits.

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Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage: a cohort study

Journal of Intensive Care ◽

10.1186/s40560-021-00540-0 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Shoujiang You ◽

Yupin Wang ◽

Zian Lu ◽

Dandan Chu ◽

Qiao Han ◽

...

Keyword(s):

Heart Rate ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Scale Score ◽

Acute Phase ◽

Coefficient Of Variation ◽

Dynamic Change ◽

Modified Rankin Scale ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage (ICH) remains unknown. We aimed to investigate the associations of heart rate trajectories and variability with functional outcome and mortality in patients with acute ICH. Methods This prospective study was conducted among 332 patients with acute ICH. Latent mixture modeling was used to identify heart rate trajectories during the first 72 h of hospitalization after ICH onset. Mean and coefficient of variation of heart rate measurements were calculated. The study outcomes included unfavorable functional outcome, ordinal shift of modified Rankin Scale score, and all-cause mortality. Results We identified 3 distinct heart rate trajectory patterns (persistent-high, moderate-stable, and low-stable). During 3-month follow-up, 103 (31.0%) patients had unfavorable functional outcome and 46 (13.9%) patients died. In multivariable-adjusted model, compared with patients in low-stable trajectory, patients in persistent-high trajectory had the highest odds of poor functional outcome (odds ratio 15.06, 95% CI 3.67–61.78). Higher mean and coefficient of variation of heart rate were also associated with increased risk of unfavorable functional outcome (P trend < 0.05), and the corresponding odds ratios (95% CI) comparing two extreme tertiles were 4.69 (2.04–10.75) and 2.43 (1.09–5.39), respectively. Likewise, similar prognostic effects of heart rate dynamic changes on high modified Rankin Scale score and all-cause mortality were observed. Conclusions Persistently high heart rate and higher variability in the acute phase were associated with increased risk of unfavorable functional outcome in patients with acute ICH.

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Prognosis of Intracerebral Hemorrhage Related to Antithrombotic Use

Stroke ◽

10.1161/strokeaha.120.030930 ◽

2021 ◽

Author(s):

Trine Apostolaki-Hansson ◽

Teresa Ullberg ◽

Mats Pihlsgård ◽

Bo Norrving ◽

Jesper Petersson

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Odds Ratio ◽

Cox Regression ◽

Multivariable Analysis ◽

Hazard Ratio ◽

Modified Rankin Scale ◽

Antithrombotic Treatment ◽

Comorbidity Burden ◽

Mortality Outcome

Background and Purpose: To date, large studies comparing mortality and functional outcome of intracerebral hemorrhage (ICH) during oral anticoagulant (OAC), antiplatelet, and nonantithrombotic use are few and show discrepant results. Methods: We used data on 13 291 patients with ICH registered in Riksstroke between 2012 and 2016 to compare 90-day mortality and functional outcome following OAC-related ICH (n=2300), antiplatelet-related ICH (n=3637), and nonantithrombotic ICH (n=7354). Univariable and multivariable Cox regression analyses, with adjustment for relevant confounders, were used to compare 90-day mortality. Early (≤24 hours and 1–7 days) and late (8–90 days) mortality was also studied in subgroup analyses. Univariable and multivariable 90-day functional outcome, based on self-reported modified Rankin Scale, was determined using logistic regression. Results: Patients with antithrombotic treatment were more often prestroke dependent, older, and had a larger comorbidity burden compared with patients without antithrombotic treatment. At 90 days, antiplatelet and OAC were associated with an increased death rate in multivariable analysis (antiplatelet ICH: hazard ratio, 1.23 [95% CI, 1.14–1.33]; OAC ICH: hazard ratio, 1.40 [95% CI, 1.26–1.57]) compared with nonantithrombotic ICH (reference). OAC ICH and antiplatelet ICH were associated with higher risk of early mortality (≤24 hours: OAC ICH: hazard ratio, 1.93 [95% CI, 1.57–2.38]; antiplatelet ICH: hazard ratio, 1.32 [95% CI, 1.13–1.54]). In multivariable analysis, the odds ratios for the association of antiplatelet and OAC treatment on functional dependency (modified Rankin Scale score, 3–5) at 90 days were nonsignificant (antiplatelet: odds ratio, 1.07 [95% CI, 0.92–1.24]; OAC: odds ratio, 0.96 [95% CI, 0.76–1.22]). Conclusions: In this large observational study, we found that 90-day mortality outcome was worse not only in OAC ICH but also in antiplatelet ICH, compared with patients with nonantithrombotic ICH. Antiplatelet ICH is common and is a serious condition with poor clinical outcome. Further studies are, therefore, warranted in determining the appropriate clinical management of these patients.

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Perihemorrhagic edema

Neurology ◽

10.1212/wnl.0000000000008129 ◽

2019 ◽

Vol 93 (12) ◽

pp. e1159-e1170 ◽

Cited By ~ 1

Author(s):

Maximilian I. Sprügel ◽

Joji B. Kuramatsu ◽

Bastian Volbers ◽

Stefan T. Gerner ◽

Jochen A. Sembill ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Functional Outcomes ◽

Time Course ◽

Multivariable Logistic Regression Analysis ◽

Lesion Volume ◽

Hematoma Volume ◽

Edema Volume ◽

Major Parameter ◽

Perihemorrhagic Edema

ObjectiveTo determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution.MethodsPatients with ICH of the prospective Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution.ResultsOverall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface (R2 = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema (R2 = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.68–4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88–1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes.ConclusionsPeak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.

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Outcomes in Antiplatelet‐Associated Intracerebral Hemorrhage in the TICH‐2 Randomized Controlled Trial

Journal of the American Heart Association ◽

10.1161/jaha.120.019130 ◽

2021 ◽

Author(s):

Zhe Kang Law ◽

Michael Desborough ◽

Ian Roberts ◽

Rustam Al‐Shahi Salman ◽

Timothy J. England ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Tranexamic Acid ◽

Functional Outcome ◽

Antiplatelet Therapy ◽

Controlled Trial ◽

Hematoma Expansion ◽

Modified Rankin Scale ◽

Double Blind ◽

Risk Of Death ◽

Increased Risk

Background Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. Methods and Results This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). Conclusions Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use. Registration URL: https://www.isrctn.com ; Unique identifier: ISRCTN93732214.

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Early Perihematomal Edema Expansion: Definition, Significance, and Association with Outcomes after Intracerebral Hemorrhage

Oxidative Medicine and Cellular Longevity ◽

10.1155/2021/6249509 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Xin-Ni Lv ◽

Zuo-Qiao Li ◽

Lan Deng ◽

Wen-Song Yang ◽

Yu-Lun Li ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Scale Score ◽

Ct Scans ◽

Absolute Increase ◽

Poor Outcome ◽

Perihematomal Edema ◽

Logistic Regression Procedure ◽

Admission Glasgow Coma Scale

Objective. To investigate the association between early perihematomal edema (PHE) expansion and functional outcome in patients with intracerebral hemorrhage (ICH). Methods. Patients with ICH who underwent initial computed tomography (CT) scans within 6 hours after the onset of symptoms and follow-up CT scans within 24 ± 12 hours were included. Absolute PHE increase was defined as the absolute increase in PHE volume from baseline to 24 hours. A receiver-operating characteristic (ROC) curve was generated to determine the cutoff value for early PHE expansion, which was operationally defined as an absolute increase in PHE volume of >6 mL. The outcome of interest was 3-month poor outcome defined as modified Rankin scale score of ≥4. A multivariable logistic regression procedure was used to assess the association between early PHE expansion and outcome after ICH. Results. In 233 patients with ICH, 89 (38.2%) patients had poor outcome at 3-month follow-up. Early PHE expansion was observed in 56 of 233 (24.0%) patients. Patients with early PHE expansion were more likely to have poor functional outcome than those without (43.8% vs. 11.8%, p < 0.001 ). After adjusting for age, admission systolic blood pressure, admission Glasgow Coma Scale score, baseline ICH volume and the presence of intraventricular hemorrhage, and time from onset to CT, early PHE expansion was associated with poor outcome (adjusted odds ratio, 4.25; 95% confidence interval, 1.70–10.60; p = 0.002 ). Conclusions. The early PHE expansion was not uncommon in patients with ICH and was correlated with poor outcome following ICH.

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Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.120.031478 ◽

2021 ◽

Vol 52 (2) ◽

pp. 611-619

Author(s):

Anne Mrochen ◽

Maximilian I. Sprügel ◽

Stefan T. Gerner ◽

Jochen A. Sembill ◽

Stefan Lang ◽

...

Keyword(s):

Platelet Count ◽

Propensity Score ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Scale Score ◽

Vitamin K ◽

Vitamin K Antagonist ◽

Modified Rankin Scale

Background and Purpose: The impact of platelets on hematoma enlargement (HE) of intracerebral hemorrhage (ICH) is not yet sufficiently elucidated. Especially the role of reduced platelet counts on HE and clinical outcomes is still poorly understood. This study investigated the influence of thrombocytopenia on HE, functional outcome, and mortality in patients with ICH with or without prior antiplatelet therapy (APT). Methods: Individual participant data of multicenter cohort studies (multicenter RETRACE program [German-Wide Multicenter Analysis of Oral Anticoagulation-Associated Intracerebral Hemorrhage] and single-center UKER-ICH registry [Universitätsklinikum Erlangen Cohort of Patients With Spontaneous ICH]) were grouped into APT and non-APT ICH patients according to the platelet count, that is, with or without thrombocytopenia (cells <150×10 9 /L). Of all patients, 51.5% (1124 of 2183) were on vitamin K antagonist. Imbalances in baseline characteristics including proportions of vitamin K antagonist patients were addressed using propensity score matching. Outcome analyses included HE (>33%), as well as mortality and functional outcome, after 3 months using the modified Rankin Scale, dichotomized into favorable (modified Rankin Scale score, 0–3) and unfavorable (modified Rankin Scale score, 4–6). Results: Of overall 2252 ICH patients, 11.4% (52 of 458) under APT and 14.0% (242 of 1725) without APT presented with thrombocytopenia on admission. The proportion of patients with HE was not significantly different between patients with or without thrombocytopenia among APT and non-APT ICH patients after propensity score matching (HE: APT patients: 9 of 40 [22.5%] thrombocytopenia versus 27 of 115 [23.5%] nonthrombocytopenia, P =0.89; non-APT patients: 54 of 174 [31.0%] thrombocytopenia versus 106 of 356 [29.8%] nonthrombocytopenia, P =0.77). In both (APT and non-APT) propensity score matching cohorts, there were no significant differences regarding functional outcome. Mortality after 3 months did not differ among non-APT patients, whereas the mortality rate was significantly higher for APT patients with thrombocytopenia versus APT patients with normal platelet count (APT: 29 of 46 [63.0%] thrombocytopenia versus 58 of 140 [41.4%] nonthrombocytopenia, P =0.01; non-APT: 95 of 227 [41.9%] thrombocytopenia versus 178 of 455 [39.1%] nonthrombocytopenia, P =0.49). Conclusions: Our study implies that thrombocytopenia does not affect rates of HE and functional outcome among ICH patients, neither in patients with nor without APT. In light of increased mortality, the significance of platelet transfusions for ICH patients with thrombocytopenia and previous APT should be explored in future studies.

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Abstract 216: Minimally Invasive Surgery plus Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Leads to a Reduction in Perihematomal Edema

Stroke ◽

10.1161/str.44.suppl_1.a216 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

W. Andrew Mould ◽

J. Ricardo Carhuapoma ◽

John Muschelli ◽

Daniel F Hanley ◽

Keyword(s):

Intracerebral Hemorrhage ◽

Degradation Products ◽

Medical Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Hematoma Evacuation ◽

Edema Volume ◽

Secondary Damage ◽

Significant Difference ◽

Perihematomal Edema

Background: Intracerebral hemorrhage (ICH) remains the most devastating form of stroke without treatment. Secondary damage such as perihematomal edema (PHE) can negatively impact long-term outcome. Several reports suggest that blood and its degradation products lead to PHE. Treatments aimed at blood removal and edema prevention have a potential to improve outcome in these stroke patients. We hypothesized that successful hematoma evacuation would reduce PHE volume. Methods: MISTIE is a multi-center, prospective, randomized trial testing the safety and efficacy of hematoma evacuation after spontaneous ICH compared to medical management. Study interventions were consistently applied in a protocol-based manner across study sites. We conducted a semi-automated, computerized volumetric analysis on CT imaging to assess the effect of hematoma removal on PHE. Both arms of the study were assessed for ICH and PHE volumes at two time points: T1, pre-enrollment, and T2, end of treatment. Results: Of 123 patients enrolled, 79 surgical and 39 medical patients were analyzed. There was no significant difference between the treatment cohorts in age, enrollment GCS, intraventricular involvement, baseline ICH volume, or baseline PHE volume. Mean hematoma volume at T2 was 19.64±14.5 cc for the surgical cohort and 40.74±13.9 cc for the medical cohort (p&lt0.001). Mean edema volume at T2 was 27.67±13.3 cc for the surgical cohort while medical patients had 41.69±14.6 cc (p&lt0.001). When patients within each treatment arm were subdivided into groups of &gt65%, 20-65%, and &lt20% ICH removal, surgical patients were 32, 39, and 8 respectively, whereas all medical patients experienced &lt20% clot removal. A significant difference in edema volume was seen among the three groups (ANOVA p&lt0.001). On further analysis, there was a positive correlation between edema reduction and percent of ICH removed: the more ICH removed, the greater the reduction in edema (Spearman R=0.645; p&lt0.001). Conclusion: Safe, early, and effective hematoma evacuation of parenchymal blood in ICH is associated with significant reduction in perihematomal edema, especially when a high percentage of blood is removed.

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