Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage

NCT ID: NCT02811614

Last Updated: 2023-02-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

733 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-07-01

Study Completion Date

2022-07-31

Brief Summary

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The effectiveness of craniotomy in the treatment of intracerebral hemorrhage remains controversial. Two main types of minimally invasive surgery, endoscopic evacuation and stereotactic aspiration, have been attempted for hematoma removal and show some advantages. However, prospective and controlled studies are still lacking. This is a multi-center randomized controlled trial designed to determine whether minimally invasive hematoma evacuation with endoscopic or stereotactic aspiration will improve the outcome in patients with hypertensive intracerebral hemorrhage compared with small-boneflap craniotomy. Patients will be randomly assigned to endoscopy group, stereotactic aspiration group or small-boneflap craniotomy group in a 1:1:1 ratio.

Detailed Description

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Hypertensive intracerebral hemorrhage (HICH) is the most common hemorrhagic stroke. The morbidity and mortality exceed 60% and only 12% patients could live independently. The choice of surgical or conservative treatment for patients with HICH is controversial.

Some minimally invasive neurosurgeries have been applied to hematoma evacuation and may improve prognosis to some extent. In endoscopic evacuation, a small burr hole is created and hematoma is removed through suction and irrigation under neuroendoscope. Endoscopic surgical evacuation promise to maximize hematoma evacuation while minimizing damage to normal tissue. Stereotactic aspiration uses image guidance to place a catheter into the main body of the hematoma and aspirate blood. It is estimated that 720 patients (240 patients in each treatment group) would provide 90% power and a type I error probability of .05 to detect an effect size of 13% with a 10% dropout rate taken into consideration. Patients will receive endoscopic evacuation, stereotactic aspiration or craniotomy according to the results of randomization. Patients will be followed up at 7 days, 30 days and 6 months.

Outcomes of different groups of patients will be collected and compared. The study is designed to find a best surgical method for hypertensive intracerebral hemorrhage.

Conditions

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Intracranial Hemorrhage, Hypertensive

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Experimental 1: Endoscopic Evacuation

Endoscopic hematoma evacuation with the help of a self-developed working channel.

Group Type EXPERIMENTAL

Endoscopic Evacuation

Intervention Type PROCEDURE

Endoscopic surgery for treatment of supratentorial hypertensive intracerebral hemorrhage.

Experimental 2: Stereotactic Aspiration

Place a catheter into the main body of the hematoma and aspirate blood.

Group Type EXPERIMENTAL

Stereotactic Aspiration

Intervention Type PROCEDURE

Using image guidance to aspirate hematoma.

Active Comparator: Craniotomy

Craniotomy with a big bone flap to for hematoma evacuation.

Group Type ACTIVE_COMPARATOR

Craniotomy

Intervention Type PROCEDURE

Craniotomy with a big bone flap to evacuate intracerebral hematoma.

Interventions

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Endoscopic Evacuation

Endoscopic surgery for treatment of supratentorial hypertensive intracerebral hemorrhage.

Intervention Type PROCEDURE

Stereotactic Aspiration

Using image guidance to aspirate hematoma.

Intervention Type PROCEDURE

Craniotomy

Craniotomy with a big bone flap to evacuate intracerebral hematoma.

Intervention Type PROCEDURE

Other Intervention Names

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neuroendoscopic surgery Hematoma Stereotactic Aspiration Craniotomy evacuation of hematoma

Eligibility Criteria

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Inclusion Criteria

* Supratentorial hypertensive intracerebral hemorrhage on CT scan with the hematoma volume ≥25mL
* Adult patients with GCS score ≥5
* Admitted within 24h of ictus

Exclusion Criteria

* Intracerebral hemorrhage caused by tumor, coagulopathy, aneurysm, or arteriovenous malformation
* Concurrent head injury or history of head injury
* Multiple intracerebral hemorrhage
* Known advanced demential or disability before
* With indications of terminal brain hernia
* Severe concomitant diseases that affect life expectancy
* Patients having taken anti-platelet or anticoagulant drugs for a long time
* With severe intraventricular hemorrhage
* Pregnant women
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jingzhou Central Hospital

OTHER

Sponsor Role collaborator

Wuhan No.1 Hospital

OTHER

Sponsor Role collaborator

Yichang Central People's Hospital

OTHER

Sponsor Role collaborator

Second Hospital of Jilin University

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Nanchang University

OTHER

Sponsor Role collaborator

Second Affiliated Hospital of Nanchang University

OTHER

Sponsor Role collaborator

Tang-Du Hospital

OTHER

Sponsor Role collaborator

First Affiliated Hospital, Sun Yat-Sen University

OTHER

Sponsor Role collaborator

Jiangmen Central Hospital

OTHER

Sponsor Role collaborator

Jilin Province People's Hospital

UNKNOWN

Sponsor Role collaborator

Siping Central People's Hospital

OTHER

Sponsor Role collaborator

Minzu Hospital of Guangxi Zhuang Autonomous Region

UNKNOWN

Sponsor Role collaborator

Taihe Hospital

OTHER

Sponsor Role collaborator

Chinese PLA General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Xiaolei Chen

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Xiaolei Chen, MD

Role: PRINCIPAL_INVESTIGATOR

Chinese PLA General Hospital

Locations

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Chinese PLA General Hospital

Beijing, Beijing Municipality, China

Site Status

Countries

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China

References

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Xu X, Zhang H, Zhang J, Luo M, Wang Q, Zhao Y, Gan Z, Xu B, Chen X; MISICH study team. Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized controlled trial. BMC Med. 2024 Jun 13;22(1):244. doi: 10.1186/s12916-024-03468-y.

Reference Type DERIVED
PMID: 38867192 (View on PubMed)

Xu X, Zheng Y, Chen X, Li F, Zhang H, Ge X. Comparison of endoscopic evacuation, stereotactic aspiration and craniotomy for the treatment of supratentorial hypertensive intracerebral haemorrhage: study protocol for a randomised controlled trial. Trials. 2017 Jun 28;18(1):296. doi: 10.1186/s13063-017-2041-1.

Reference Type DERIVED
PMID: 28659171 (View on PubMed)

Other Identifiers

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Chinese PLA General Hospital

Identifier Type: -

Identifier Source: org_study_id

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