Minimally invasive endoscopic hematoma evacuation vs best medical management for spontaneous basal-ganglia intracerebral hemorrhage
| Autor: | Andrei V. Alexandrov, Christopher Nickele, David Fiorella, Konark Malhotra, Khalid Alsherbini, Abhi Pandhi, Adam S Arthur, Aristeidis H. Katsanos, Nitin Goyal, Lucas Elijovich, Georgios Tsivgoulis, Jason J. Chang, Daniel Hoit |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Pilot Projects 030204 cardiovascular system & hematology Single Center law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Modified Rankin Scale Humans Minimally Invasive Surgical Procedures Medicine Hospital Mortality Prospective Studies Hematoma evacuation Aged Retrospective Studies Intracerebral hemorrhage medicine.diagnostic_test business.industry Stroke scale Basal Ganglia Hemorrhage Disease Management General Medicine Middle Aged medicine.disease Surgery Endoscopy Treatment Outcome Case-Control Studies Neuroendoscopy Cohort Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Journal of NeuroInterventional Surgery. 11:579-583 |
| ISSN: | 1759-8486 1759-8478 |
| Popis: | BackgroundWe 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).MethodsWe 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.ResultsAmong 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 cm3 (IQR, 25–50) vs 15 cm3 (IQR, 5–20); PConclusionsMinimally 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. |
| Databáze: | OpenAIRE |
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