Earlier this week, the American Heart Association (AHA) released an evidence update regarding minimally invasive surgical evacuation of supratentorial spontaneous intracerebral hemorrhage (ICH). This update follows the publication of two RCTs (ENRICH [NCT02880878] and MIND [NCT03342664]) that compared minimally invasive surgery with medical management for ICH. The results of the trials warranted the update from the AHA in part due to the broadening consideration for surgical treatment of certain patients, which had historically been limited due to concerns regarding procedural risks and lack of functional improvement.
The ENRICH trial revealed notable six-month functional benefits over medical management based on analysis of utility-weighted mRS scores and improved 30-day mortality. The MIND trial achieved high technical efficacy with fewer serious adverse events in the minimally invasive surgery group after an exploratory analysis, but showed no significant reduction in mortality or improvement in functional outcomes by the end-point. Exploratory analysis did indicate improved clinical outcomes at 30 days with minimally invasive surgical evacuations. Both the ENRICH and MIND trials did not enroll patients older than 80 years of age.
The following is a rundown of key points from the update. View the full-text version for the complete look at the AHA evidence update.
- The ENRICH trial tested a tubular retractor that is placed with neuronavigation through a brain sulcus to avoid critical white matter tracts.
- The ENRICH trial found improved outcomes, parimarily for lobar hemorrhages.
- The MIND trial evaluated minimally invasive surgical evacuation using an endoscope and mechanical aspiration device for clot evacuation.
- The MIND trial found high rates of technical success and safety, despite neutral results.
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