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Early Minimally Invasive Surgery Improves Intracerebral Hemorrhage Stroke Outcomes

By HospiMedica International staff writers
Posted on 07 Jun 2024
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Image: The Myriad device enables safe, automated brain tumor removal and clot evacuation (Photo courtesy of NICO)
Image: The Myriad device enables safe, automated brain tumor removal and clot evacuation (Photo courtesy of NICO)

According to the World Stroke Organization, there are over 3.4 million new cases of intracerebral hemorrhages (ICH) — a type of stroke caused by bleeding within the brain — each year, accounting for more than 28% of all incident strokes. In the United States, over half of these patients die within 30 days of experiencing a hemorrhage. A new study has revealed that patients with an ICH have better medical outcomes when surgeons perform an early minimally invasive removal of the hematoma compared to those who receive the standard of care.

Researchers at Indiana University School of Medicine (Indianapolis, IN, USA) evaluated the results of the ENRICH trial, a randomized clinical trial designed to assess the effectiveness, safety, and economics of a minimally invasive neurosurgery technique. The ENRICH trial involved 300 patients across 37 centers in the U.S., who either had a lobar (208 patients) or anterior basal ganglia hemorrhage (92 patients) with a hematoma volume between 30-80 mL. These patients were randomized into two groups: surgery/medical management and medical management. Neurosurgeons utilized BrainPath and Myrid devices, developed by the NICO Corporation (Carmel, IN, USA), to perform the surgery. The BrainPath device allowed surgeons to create a path to the bleeding site by gently displacing brain tissue. Once in place, the Myrid device, an automated suction and resection tool, was used to remove the hematoma from the brain.

The study showed that nearly three-fourths of the surgical group saw their blood clot volume decrease to 15 mL or less after surgery performed within 24 hours. At 30 days post-hemorrhage, 90.7% of surgery patients survived compared to 82% of medical management patients. The research concluded that patients with an ICH who underwent minimally invasive surgical evacuation of a brain blood clot and received guideline-based medical management within 24 hours had better survival rates and functional outcomes at 180 days compared to those who only received medical management.

“We can offer early clot removal in patients with an intracerebral hemorrhage and tell our patients that they have better outcomes and survival. The families of the patients can ultimately see patients leave the hospital sooner,” said Mitesh Shah, MD, a faculty clinician at the Indiana University School of Medicine and chair of the Department of Neurological Surgery.

“By evacuating the clot with this early intervention, we can increase survivability and reduce the number of days spent in critical care and reduce health care costs,” added Bradley Bohnstedt, a faculty clinician at the university.

Related Links:
IU School of Medicine
NICO Corporation

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