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MINIMALLY INVASIVE SURGERY plus T-PA for
INTRACEREBRAL HEMORRHAGE EVACUATION
Intracerebral Hemorrhage (ICH) is the only major stroke subtype (ischemic, aneurysm rupture, and parenchymal hemorrhage) without a clearly effective treatment. ICH occurs in over 100,000 Americans yearly. African Americans, Hispanics and Asians are disproportionately affected. ICH is fatal in 30 to 50% of all occurrences. It leaves the majority of the survivors with significant motor and cognitive disability. Compared to ischemic stroke, ICH is easily and rapidly identified, occurs in younger patients, and produces a smaller initial injury to cerebral tissues—all factors suggesting that interventional amelioration is possible. The investigations of the last decade have established that the extent of ICH-mediated brain injury relates directly to the volume of blood clot and duration of blood exposure to the brain tissue. We propose to produce data regarding the capability of minimally invasive surgery (MIS) with recombinant tissue plasminogen activator (rt-PA) to remove blood clot from ICH patients.
The MISTIE study was designed to unearth previously unavailable data about ICH dissolution and different doses of rt-PA, a safety estimate for MIS + rt-PA, in-situ pharmacokinetic behavior and dose-response properties, surgical data regarding the validity and safety of patient selection, quantitation of surgical effectiveness, and objective definitions of patient stability and disease/treatment-related complications. These previously unavailable data are critical to precisely defining a treatment for this last, untreated stroke type: ICH. This proposed study would provide the first test of the relation between clot removal and outcome for brain hemorrhage.
Click Here for information on the ICES (Endoscopy) arm of the MISTIE-ICES trial.