Comparison of different innovative minimally invasive techniques for ICH
| Study | Type of study | Method of ICH evacuation | No of patients | Neurological outcome | ICH score | Preoperative volume (cm3) | % ICH removal | % ICH-related mortality | Procedure-related complications | Limitations |
| BrainPath | ||||||||||
| Prybylowski et al 41 | Retrospective case series | EAME with BrainPath System | 11 | 36% functionally independent at 90-day follow-up, 2 mildly functional independent | 2 (range:1–4) | 51 (range 9–168) | 87% (38%–99%) | 36 | Haemorrhage: n=1 | Small sample size, retrospective nature |
| Bauer et al 42 | Prospective, single-centre study (pilot) | BrainPath system | 18 | GCS increase preoperatively 10–14 pts | 2.4 (SD 1.0) | 52.7 mL (SD 22.9) | 95.7 (SD 5.8) | 5.60 | None reported | Small sample size, single centre |
| Labib et al 46 | Retrospective multicentre study | Mi SPACE approach | 39 | Increased GCS from 10 to 15 pts | 2 (range: 0–3) | 36 (range: 27–65) | >90% in 72% of patients, 75%–89% in 23% of patients and 50%–75% in 5% of patients | 0 | Rebleed (n=1), middle cerebral artery perforator infarct (n=1) | Retrospective nature |
| Griessenauer et al 52 | Retrospective matched cohort | BrainPath system | 5 | Preoperatively GCS 10, postoperatively GCS 3 | 2 (1–3) | 42.3 (SD 9.1) | – | 2 (40) | None reported | Retrospective nature, small sample size, delayed treatment time |
| Apollo System | ||||||||||
| Spiotta et al 50 | Multicentre, retrospective case series | Apollo System | 29 | Acute neurological deficits (n=12), chronic neurological deficits(n=2) | – | 45.4 (SD 30.8) | 54.1% (SD 39.1) | 13.80 | Rebleeding and increased oedema, decompressive craniectomy (n=2) | Retrospective, delayed TTT |
| Griessenauer et al 52 | Retrospective Matched cohort | Apollo System | 5 | Preoperative GCS 9, postoperative GCS 10 | 3 (range: 1–4) | 50.7 (SD 23.9) | – | 40 (2) | No postoperative complications | Retrospective nature, small sample size, delayed TTT |
| Kellner et al 51 | Retrospective case series | SCUBA with Apollo System | 47 | – | – | 42.6 (SD 29.7) | 88.2% (SD 20.8) | – | Bleeding: IO,6.4% (n=3) and PO, 2.1% (n=1). | Functional outcome /ICH characteristics not in article |
| Goyal et al 49 | Retrospective case–control study | Apollo System | 18 | – | 2.2 (SD 0.9) | 40 (range: 21–52) | 60% (median: 24 cm3) | 28 | – | Retrospective, assessment of imaging ICH volumes not adjudicated. Disparities in withdrawal of care |
| Catheter-based pharmacological techniques | ||||||||||
| Hanley et al 57 | Multicentre, phase II clinical trial | MISTIE II | 96 (54 MIS +alteplase, 42 SMC) | Admission GCS: 3–8 pts (n=17), 9–12 pts (n=12), 13–15 pts (n=17) | – | 48.2 (SD 19.6) | 57% (SD 25) | 9.50 | Symptomatic bleeding (n=5), asymptomatic haemorrhage (n=3) | Small trial size and low screening yield. Did not evaluate efficacy |
| Hanley et al 58 | Multicentre, open-label phase III clinical trial | MISTIE III | 499 (250 MIS+alteplase, 249 SMC) | Admission GCS: 3–8 pts (n=64), 9–12 pts (n=111), 13–15 pts (n=75 | – | 41.8 (range: 30.8–54.5) | 69% | 9 | Symptomatic bleeding (n=6), bacterial infections (n=2) 30% serious adverse event at 30 days | Open-label design, use of different sizes and surgeons to perform the procedure |
GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; MIC, minimally invasive surgery; SMC, standard medical care.