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Post-Trial Enhanced Deployment and Technical Performance with the MISTIE Procedure per Lessons Learned.

Ali Mansour1, Andrea Loggini2, Faten El Ammar2

  • 1Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
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Minimally invasive surgery and thrombolysis for intracerebral hemorrhage (ICH) evacuation (MISTIE) shows improved deployment and technical success rates in clinical practice post-trial. Artificial intelligence aids in accurate ICH volume assessment.

Keywords:
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Area of Science:

  • Neurosurgery
  • Minimally Invasive Procedures
  • Intracerebral Hemorrhage Management

Background:

  • The MISTIE (Minimally Invasive Surgery and Thrombolysis for Intracerebral Hemorrhage Evacuation) Phase III trial established protocols for ICH evacuation.
  • Post-trial evaluation is crucial to assess the adaptability and efficacy of MISTIE in routine clinical practice.

Purpose of the Study:

  • To evaluate if procedure deployment rates and technical performance of MISTIE can be enhanced in clinical practice after the Phase III trial.
  • To compare MISTIE outcomes in a real-world setting with trial data.
  • To assess the accuracy of different methods for measuring hematoma volume, including a novel AI approach.

Main Methods:

  • Retrospective analysis of 19 intracerebral hemorrhage patients who underwent MISTIE between 2017-2021 at a single institution post-Phase III trial enrollment.
  • Comparison of deployment rates, complications, and technical outcomes with MISTIE Phase III trial data.
  • Evaluation of initial and final hematoma volumes using ABC/2 method, manual segmentation, and an Artificial Intelligence (AI)-based volume assessment.

Main Results:

  • MISTIE deployment rate was 6.6% (19/286) in post-trial practice versus 1.6% during the trial (p=0.0018).
  • Technical success, defined as < 15 mL residual ICH or > 70% removal, was achieved in 84% of patients, significantly higher than the trial's 59.7% (p=0.034).
  • AI-based ICH volume assessment demonstrated excellent correlation with manual segmentation, highlighting limitations of the ABC/2 method.

Conclusions:

  • Post-trial clinical practice allows for greater MISTIE procedure deployment and higher technical success rates compared to the MISTIE III trial.
  • AI-based volume measurements can improve the accuracy of clinician-estimated ICH volumes.
  • Further trials are needed to determine the clinical outcome implications of this enhanced technical performance.