Τίτλος:
Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background We conducted a case-control study to assess the relative safety and efficacy of minimally invasive endoscopic surgery (MIS) for clot evacuation in patients with basal-ganglia intracerebral hemorrhage (ICH). Methods We evaluated consecutive patients with acute basal-ganglia ICH at a single center over a 42-month period. Patients received either best medical management according to established guidelines (controls) or MIS (cases). The following outcomes were compared before and after propensity-score matching (PSM): in-hospital mortality; discharge National Institutes of Health Stroke Scale score; discharge disposition; and modified Rankin Scale scores at discharge and at 3 months. Results Among 224 ICH patients, 19 (8.5%) underwent MIS (mean age, 50.9±10.9; 26.3% female, median ICH volume, 40 (IQR, 25-51)). The interventional cohort was younger with higher ICH volume and stroke severity compared with the medically managed cohort. After PSM, 18 MIS patients were matched to 54 medically managed individuals. The two cohorts did not differ in any of the baseline characteristics. The median ICH volume at 24 hours was lower in the intervention group (40 cm 3 (IQR, 25-50) vs 15 cm 3 (IQR, 5-20); P<0.001). The two cohorts did not differ in any of the pre-specified outcomes measures except for in-hospital mortality, which was lower in the interventional cohort (28% vs 56%; P=0.041). Conclusions Minimally invasive endoscopic hematoma evacuation was associated with lower rates of in-hospital mortality in patients with spontaneous basal-ganglia ICH. These findings support a randomized controlled trial of MIS versus medical management for ICH. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Συγγραφείς:
Goyal, N.
Tsivgoulis, G.
Malhotra, K.
Katsanos, A.H.
Pandhi, A.
Alsherbini, K.A.
Chang, J.J.
Hoit, D.
Alexandrov, A.V.
Elijovich, L.
Fiorella, D.
Nickele, C.
Arthur, A.S.
Περιοδικό:
Journal of Neurointerventional Surgery
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
antithrombocytic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor, adult; Article; basal ganglion hemorrhage; brain hematoma; brain hemorrhage; case control study; cerebrovascular accident; cohort analysis; controlled study; diastolic blood pressure; endoscopy; female; hospital admission; human; hyperlipidemia; international normalized ratio; length of stay; major clinical study; male; middle aged; minimally invasive procedure; National Institutes of Health Stroke Scale; outcome assessment; priority journal; propensity score; Rankin scale; retrospective study; systolic blood pressure; young adult; aged; basal ganglion hemorrhage; comparative study; diagnostic imaging; disease management; hospital mortality; minimally invasive surgery; mortality; neuroendoscopy; pilot study; procedures; prospective study; standards; treatment outcome; trends, Adult; Aged; Basal Ganglia Hemorrhage; Case-Control Studies; Cohort Studies; Disease Management; Female; Hospital Mortality; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neuroendoscopy; Pilot Projects; Prospective Studies; Retrospective Studies; Treatment Outcome
DOI:
10.1136/neurintsurg-2018-014447
