Removing Blood Via Minimally Invasive Surgery Improves Recovery

According to a study presented at the AHA/ASA International Stroke Conference 2019, “The greater the volume of blood removed from the brain via minimally invasive surgery after a hemorrhagic stroke the greater the odds of better functional recovery.”

During the late breaking science portion of the conference researchers presented results from the Minimally Invasive Surgery Plus Altephase for Intracerebral Hemorrhage Evacuation (MISTIE) trial. MISTIE procedure calls for “the stereotactic catheter aspiration and clearance of large bleeds within the brain, with the clot-buster alteplase.”

The trial consisted of 506 intracerebral hemorrahage (ICH) cases, 242 ICH patients with an average age of 62 years, 110 surgeons at 73 sites, and follow up after one year. Patients with unstable bleeding or cerebellar/brainstem hemorrhage were excluded from the trial. 

Researchers concluded that among “cases undergoing the MISTIE III surgical procedure, removing blood volume by 70 percent or more, or leaving 15 milliliters or less of residual blood at the end of treatment were twice as likely to achieve milder disability one year later.”

The study also found, “Lesser removal was needed to avoid mortality, but the patients who had less than 70 percent of the blood removed, or more than 15 mL residual blood, had no difference in disability than patients treated with medical therapy, or those with lesser removal.” 

“When assessing the results of surgery for brain hemorrhage, it is critical to consider how much blood was successfully evacuated. Unless a large majority of clot is removed and only a very small residual of blood is left, the full benefits of surgery will not be realized,” said Issam A. Awad, MD, MSc, study lead author and director of neurovascular surgery at the University of Chicago Medicine and Biological Sciences. “This had never been considered as a factor in the success or failure of such surgeries and cannot be taken for granted.”—Edan Stanley