Abstract WMP79: Catheter Placement and Surgical Training in the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation Trial
INTRODUCTION: One goal of the Minimally Invasive Surgery Plus rt-PA for Intracerebral Hemorrhage Evacuation (MISTIE) trial was to assess variability in surgical performance. We hypothesized that less variability in surgical technique and catheter placement would improve ICH removal.
Methods: Upon review of catheter placements in stage 1 of the MISTIE trial, we developed a 150-point scoring system to assess the catheter engagement with the parenchymal clot and analyzed this compared to clot volume reduction. We also explored whether ideal clot engagement would be more likely using one of three predetermined trajectories. To improve surgical performance in the second stage of the trial, surgeons were systematically retrained via webinars, teleconferences and consensus presentations emphasizing the importance of choosing the ideal trajectory. Additionally, prior to surgey, the surgical team was required to plan catheter placement by choosing one of the three trajectories. This choice was prospectively reviewed by the trial’s centralized surgical center to optimize surgical technique.
Results: Pre-surgery ICH was similar across stage 1 (46.2 cc, n=46) and stage 2 (42.1 cc, n=35). In stage 1, a higher catheter placement score correlated to a higher percentage of clot removed (Spearman r = 0.569, p < 0.001). Following surgical standardization, mean catheter placement score (±SD) improved from 80.3 (±4.2) in stage 1 to 99.3 (±5.9) in stage 2 (p=0.011). Surgical patients in stage 2 experienced a 59.4% clot reduction on average compared to 47.5% in stage 1 (trend, p=0.083). Also, more patients from stage 2 (54%) had less than 15 cc of blood remaining at the end of treatment compared to stage 1 (35%, one-sided p=0.063), which has been shown to predict good functional outcomes.
Conclusion: Controlling the catheter trajectory can optimize catheter engagement with the clot and improve ICH removal. Reliable catheter placement can be achieved in a multicenter clinical trial through surgical training.
- © 2012 by American Heart Association, Inc.