The removal of more blood by minimally invasive surgery improves the recovery of stroke

The greater the volume of blood drawn in the brain by minimally invasive surgery after cerebral hemorrhage is important, the better the chances of a better functional recovery, according to a recent scientific study presented at the International Stroke Conference. 2019 of the American Stroke Association, clinicians dedicated to the science and treatment of cerebrovascular disease.

Minimally invasive surgery plus alteplase for the evacuation of intracerebral hemorrhage (MISTIE) is stereotactic catheter aspiration and elimination of significant bleeding in the brain, with l & # 39; clot alteplase-bust.

The MISTIE III trial is the first evaluation of a surgical trial to determine whether a significant blood extraction would impact the likelihood of a favorable functional outcome after one year and the factors badociated with a greater efficiency of the blood extraction.

Among 506 cases of intracerebral hemorrhage (ICH) included in the trial, 242 patients (according to an average age of 62 years, 63% of men) underwent the MISTIE III surgical procedure by 110 surgeons on 73 sites, with follow-up at one year. The trial excluded patients whose bleeding had not stabilized and cases of cerebellar and brainstem bleeding.

The researchers found that, among the cases undergoing the MISTIE III surgical procedure, a reduction in blood volume of 70% or more, or a residual amount of blood of 15 milliliters or less at the end of treatment, was twice as likely to to achieve mild disability one year later. Less elimination was necessary to avoid mortality, but patients with less than 70% of the blood removed, or more than 15 ml of residual blood, showed no difference in terms of disability compared to treated patients. by medical treatment or to those whose extraction was less important.

The researchers noted that a more effective PCI evacuation was probably more effective in cases of bruising of certain forms, in which the surgical protocol was rigorously followed, as well as by surgeons and sites with the most severe great experience of the MISTIE technique.

"When evaluating the outcome of a surgery for cerebral hemorrhage, it is essential to take into account the volume of blood evacuated successfully, unless a large majority of the clot is removed and that it is not necessary. there remains only a very small blood residue, the benefits of surgery will not be fully exploited. ", said Issam A. Awad, MD, M.Sc., lead author of the study and director Neurovascular Surgery at the University of Chicago in Medicine and Biosciences. "This has never been considered a factor in the success or failure of such surgeries and can not be taken for granted. "