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MISTIE III Provides Valuable Data on Intracerebral Hemorrhage

March 19, 2019

A neurosurgical clinical trial that did not meet its primary endpoint offers valuable clues nonetheless, argue the authors of a commentary published in The Journal of NeuroInterventional Surgery. The paper spotlights the value of data produced by the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation (MISTIE III) trial. The authors note that though the MISTIE III trial did not reach its primary endpoint of good functional outcome at one year, it did generate ample high-quality data that offer insights about surgical treatment for intracerebral hemorrhage.

MISTIE III was an open-label, blinded-endpoint phase 3 trial of patients with intracerebral hemorrhage randomized to minimally invasive surgery or standard medical treatment. Participants enrolled in the trial had clots of 30 mL or more and the investigators’ surgical goal was to reduce clots to ≤15 mL. The proportion of surgical patients who reached a good functional outcome, defined as a modified Rankin Scale score of 0-3, was not significantly greater than for patients treated with the standard medical approach.

The surgical goal was only achieved in 58% of patients in that study arm, but those patients did have better outcomes compared to surgical patients that did not see a reduction to ≤15 mL as well as to patients in the standard treatment arm.

“This trial suggests that some combination of technology and technique that can reliably leave ≤15 mL residual hematoma is needed,” write the authors led by Christopher P. Kellner, an assistant professor of neurosurgery at Icahn School of Medicine at Mount Sinai in New York. Additionally, they note that an exploratory analysis pointed towards a benefit when the hematoma volume was reduced to at least 20 mL.

The authors highlight several ongoing research efforts in this area and foresee a bright future for improvements in ICH treatment.