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

作　　者：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 

机构地区：[1]The George Institute for Global Health,Beijing,China [2]Department of Neurology,Division of Neurocritical Care,Johns Hopkins Medical Institutions,Baltimore,Maryland,USA [3]Department of Neurology,Division of Brain Injury Outcomes,Johns Hopkins Medical Institutions Campus,Baltimore,Maryland,USA [4]Department of Neurology,Weill Cornell Medical College,New York,New York,USA [5]Department of Emergency Medicine,Massachusetts General Hospital,Boston,Massachusetts,USA [6]Department of Neurosurgery,West China Hospital of Medicine,Chengdu,Sichuan,China [7]Department of Neurosurgery,University of Chicago Pritzker School of Medicine,Chicago,Illinois,USA

出　　处：《Stroke & Vascular Neurology》2024年第4期446-456,I0147,共12页卒中与血管神经病学（英文）

基　　金：supported by a grant from the National Institute of Neurological Disorders and Stroke(1U01NS080824).

摘　　要：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.

关 键 词：SURGERY SURGERY ABSENCE 

分 类 号：R743.34[医药卫生—神经病学与精神病学]