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Literature: ICH Clinical Trials TOPIC

Clinical Trial

Inclusion Criteria Hematoma Volume Surgery Medical

Result

STICH I

 

Spontaneous ICH,72 hours post ictus

GCS > 5

 Minimum hematoma diameter 2cm N=503

Early surgery within 24 hours of randomization

N=530 Favorable Outcome
Surgery: 26%
Medical: 24%
-Small non-significant advantage for surgery

STICH II

Spontaneous Lobar hemorrhage < 1cm from cortical surface -within 48 hours post ictus

 

GCS 5 or 6 (best eye score 2 or more)

10cc to 100 cc lobar hemorrhage with no IVH

 

N=307

Within 12 hours

N=294 a)Favorable outcome
Surg 123 (41%)
Med 108 (38%)b)Unfavorable outcome
Surg: 174 (59%)
Med: 178 (62%)c)Death at 6mos
Surg  54 (18%)
Med  69 (24%)
Early surgery does not increase the rate of death or disability at 6 months with small survival advantage

MISTIE II

Spontaneous ICH

GCS <  14

NIHSS > 6

a)ICH

>  20cc and <40cc

 

b)ICH >40

MIS+rtpa

N= 54

N= 42 a) Symp hemorrhages
Medical 1
Surg: 5b)Asymp Hemorrhage
Medical: 3
Surg: 12c) MRS 0–3 at 180 days
MISPA: 33%
Medical :21%
MIS+rt-PA appears safe with apparent advantage of better functional outcome at 180 days but with Increased asymptomatic bleeding

MISTIE 3

Spontaneous supratentorial

Symptom within 24Hrs

Randomization within 12-72 hrs

ICH > 30 N255

MIS +rTPA

N=251  For moderate sized hematoma, MISTIE did not improve the proportion of patients who achieved a good response 365 days after intracerebral haemorrhage

References: see Suggested Reading List ((2) JP Broderick; Stroke.2005;36:1619–1620; (3) Mendelow, Gregson and Rowan. 2013; 382(9890)397; (4) Mould et al. Stroke. 2013;44:627–634; (5) Hanley et al. Lancet. 2019;393(10175):1021-1032)