The minimally invasive surgery tested in MISTIE is probably the most promising approach developed for treating the devastating disease of intracerebral hemorrhage.
The results showed a 10% increase in the rate of patients recovering to a modified Rankin Scale score of 1-3, is a pretty significant result. It results in less disability for patients and less burden to their families.
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The most important predictor of outcome was the size of the clot; if you can do anything meaningful to reduce the size, it should benefit patients. But aggressiveness in removing clot must be balanced against minimizing manipulation of brain tissue. The goal is to remove as much clot as possible without doing damage. The results did not include information on brain edema following surgery, but it looks like despite the trauma of intervention patients on balance had better outcomes.
This was a phase II study, so the results now need to be replicated in additional patients. At this point, it remains ethical to randomize patients to receive either this treatment or conventional therapy. This is a very important treatment to further examine.
Dr. Steven R. Levine is professor of neurology and emergency medicine at State University of New York, Brooklyn. He said that he had no disclosures. Dr. Levine made these comments in an interview.
FROM THE INTERNATIONAL STROKE CONFERENCE
