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

Primary Purpose

Intracranial Hemorrhage, Hypertensive

Status
Completed
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Endoscopic Evacuation
Stereotactic Aspiration
Craniotomy
Sponsored by
Chinese PLA General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Intracranial Hemorrhage, Hypertensive focused on measuring intracerebral hemorrhage,hypertensive, minimally invasive surgery, neuroendoscopic surgery, stereotactic aspiration

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Supratentorial hypertensive intracerebral hemorrhage on CT scan with the hematoma volume >20mL
  • 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

Sites / Locations

  • Chinese PLA General Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Experimental 1: Endoscopic Evacuation

Experimental 2: Stereotactic Aspiration

Active Comparator: Craniotomy

Arm Description

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

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

Craniotomy with a big bone flap to for hematoma evacuation.

Outcomes

Primary Outcome Measures

Modified Rankin Scale
The degree of disability or dependence in the daily activities. The scale runs from 0-6, running from perfect health without symptoms to death.

Secondary Outcome Measures

Hematoma Clearance Rate
A ratio assessing extent of hematoma evacuation, ranging from 0 to 100%.
Operation Time
The time from skin incision to the end of surgery.
Intraoperative Blood Loss
Volume of blood lost during operation.
Postoperative Glasgow Coma Scale
A neurological scale to record the conscious state of patients at 1 week after surgery.
Rebleeding Rate
The percentage of patients that suffer from rebleeding after surgery. Rebleeding usually occurs within 3 days after surgery.
Days of ICU Stay
The time an ICH patient has to stay in intensive care unit after surgery.
Mortality
The percentage of patients that die within a month after the onset of hypertensive intracerebral hemorrhage.
Intracranial Infection Rate
Percentage of patients that get intracranial infection. The infection should be confirmed by cerebrospinal fluid tests.
Barthel Index
An ordinal scale used to measure performance of patients in activities of daily living. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital.
Hospitalization expenses
Total expenses during neurosurgery hospitalization

Full Information

First Posted
June 20, 2016
Last Updated
February 20, 2023
Sponsor
Chinese PLA General Hospital
Collaborators
Jingzhou Central Hospital, Wuhan No.1 Hospital, Yichang Central People's Hospital, Second Hospital of Jilin University, The First Affiliated Hospital of Nanchang University, Second Affiliated Hospital of Nanchang University, Tang-Du Hospital, First Affiliated Hospital, Sun Yat-Sen University, Jiangmen Central Hospital, Jilin Province People's Hospital, Siping Central Hospital, Minzu Hospital of Guangxi Zhuang Autonomous Region, Taihe Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02811614
Brief Title
Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage
Acronym
MISICH
Official Title
Minimally-invasive Surgery Versus Craniotomy in Patients With Supratentorial Hypertensive Intracerebral Hemorrhage: A Multi-center Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Completed
Study Start Date
July 1, 2016 (Actual)
Primary Completion Date
June 30, 2022 (Actual)
Study Completion Date
July 31, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Chinese PLA General Hospital
Collaborators
Jingzhou Central Hospital, Wuhan No.1 Hospital, Yichang Central People's Hospital, Second Hospital of Jilin University, The First Affiliated Hospital of Nanchang University, Second Affiliated Hospital of Nanchang University, Tang-Du Hospital, First Affiliated Hospital, Sun Yat-Sen University, Jiangmen Central Hospital, Jilin Province People's Hospital, Siping Central Hospital, Minzu Hospital of Guangxi Zhuang Autonomous Region, Taihe Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
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
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Intracranial Hemorrhage, Hypertensive
Keywords
intracerebral hemorrhage,hypertensive, minimally invasive surgery, neuroendoscopic surgery, stereotactic aspiration

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
733 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Experimental 1: Endoscopic Evacuation
Arm Type
Experimental
Arm Description
Endoscopic hematoma evacuation with the help of a self-developed working channel.
Arm Title
Experimental 2: Stereotactic Aspiration
Arm Type
Experimental
Arm Description
Place a catheter into the main body of the hematoma and aspirate blood.
Arm Title
Active Comparator: Craniotomy
Arm Type
Active Comparator
Arm Description
Craniotomy with a big bone flap to for hematoma evacuation.
Intervention Type
Procedure
Intervention Name(s)
Endoscopic Evacuation
Other Intervention Name(s)
neuroendoscopic surgery
Intervention Description
Endoscopic surgery for treatment of supratentorial hypertensive intracerebral hemorrhage.
Intervention Type
Procedure
Intervention Name(s)
Stereotactic Aspiration
Other Intervention Name(s)
Hematoma Stereotactic Aspiration
Intervention Description
Using image guidance to aspirate hematoma.
Intervention Type
Procedure
Intervention Name(s)
Craniotomy
Other Intervention Name(s)
Craniotomy evacuation of hematoma
Intervention Description
Craniotomy with a big bone flap to evacuate intracerebral hematoma.
Primary Outcome Measure Information:
Title
Modified Rankin Scale
Description
The degree of disability or dependence in the daily activities. The scale runs from 0-6, running from perfect health without symptoms to death.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Hematoma Clearance Rate
Description
A ratio assessing extent of hematoma evacuation, ranging from 0 to 100%.
Time Frame
24 hours and 3 days
Title
Operation Time
Description
The time from skin incision to the end of surgery.
Time Frame
24 hours
Title
Intraoperative Blood Loss
Description
Volume of blood lost during operation.
Time Frame
24 hours
Title
Postoperative Glasgow Coma Scale
Description
A neurological scale to record the conscious state of patients at 1 week after surgery.
Time Frame
7 days
Title
Rebleeding Rate
Description
The percentage of patients that suffer from rebleeding after surgery. Rebleeding usually occurs within 3 days after surgery.
Time Frame
3 days
Title
Days of ICU Stay
Description
The time an ICH patient has to stay in intensive care unit after surgery.
Time Frame
14 days
Title
Mortality
Description
The percentage of patients that die within a month after the onset of hypertensive intracerebral hemorrhage.
Time Frame
30 days
Title
Intracranial Infection Rate
Description
Percentage of patients that get intracranial infection. The infection should be confirmed by cerebrospinal fluid tests.
Time Frame
7 days
Title
Barthel Index
Description
An ordinal scale used to measure performance of patients in activities of daily living. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital.
Time Frame
6 months
Title
Hospitalization expenses
Description
Total expenses during neurosurgery hospitalization
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Xiaolei Chen, MD
Organizational Affiliation
Chinese PLA General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chinese PLA General Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100853
Country
China

12. IPD Sharing Statement

Plan to Share IPD
Yes
Citations:
PubMed Identifier
28659171
Citation
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.
Results Reference
derived

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

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