Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage
Published on: April 29, 2024
New research from the ENRICH trial shows that for patients with acute intracerebral hemorrhage (ICH), performing minimally invasive hematoma evacuation within 24 hours, plus guideline-based medical management, led to better functional outcomes at 180 days compared with those who received only guideline-based medical management. The randomized, adaptive clinical trial was conducted in 37 U.S. hospitals from 2017 to 2023 and enrolled 300 patients with spontaneous hemorrhagic stroke with a hematoma volume of 30-80 ml: 92 patients with a hemorrhage in the anterior basal ganglia location and 208 in the lobar location. At 180 days, the mean score on the utility-weighted modified Rankin scale was 0.458 in the surgery group and 0.374 in the group that received only guideline-based medical management. For patients with lobar hemorrhages, the mean between-group difference was 0.127, while the mean between-group difference for patients with anterior basal ganglia hemorrhages was -0.013. At 30 days, 9.3% of the surgery group and 18.0% of the control group had died. Postoperative rebleeding and neurologic deterioration after surgery occurred in 3.3% of the surgery group. One or more serious adverse events were reported in 63.3% of the surgery group and 78.7% of the control group. “The results in the pooled analysis appeared to be attributable to the surgery effect in the lobar hemorrhage location,” the researchers conclude.