Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage

Yunke Li, Sung Min Cho, Radhika Avadhani, Hassan Ali, Yi Hao, Santosh B. Murthy, Joshua N. Goldstein, Fan Xia, Xin Hu, Natalie L. Ullman, Issam Awad, Daniel Hanley, Wendy C. Ziai

Research output: Contribution to journalArticlepeer-review

Abstract

Background Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes. Methods Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial's primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models. Results Of 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30-53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all P interaction >0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05-0.42); P interaction =0.006), absence of lacunes (OR, 0.37 (0.18-0.80); P interaction =0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08-0.58); P interaction =0.03). Conclusions Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS.

Original languageEnglish (US)
Pages (from-to)446-456
Number of pages11
JournalStroke and Vascular Neurology
Volume9
Issue number4
DOIs
StatePublished - Aug 27 2024

Keywords

  • Clinical Trial
  • Magnetic Resonance Imaging
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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