TY - JOUR
T1 - Rate and Predictors of Unanticipated Surgical Evacuation in Patients with Intracerebral Hemorrhage
T2 - Post Hoc Analysis of ATACH 2 Trial
AU - Qureshi, Adnan I.
AU - Lobanova, Iryna
AU - Huang, Wei
AU - Saeed, Omar
AU - Suarez, Jose I.
N1 - Funding Information:
Conflict of interest statement: Supported by the National Institute of Neurological Disorders and Stroke (U01-NS062091, to Dr. Qureshi). No potential conflict of interest relevant to this article was reported.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/9
Y1 - 2020/9
N2 - Background: We performed this analysis to identify the rates, predictors, and associated outcomes of unexpected neurosurgical evacuation in a multicenter randomized clinical trial, Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) 2. Methods: The ATACH 2 trial determined the efficacy of antihypertensive treatment in patients with spontaneous supratentorial intracerebral hemorrhages (ICHs) with a Glasgow Coma Scale (GCS) score of ≥5 and intraparenchymal hematoma volume of <60 cm3 on initial computed tomographic scan. We determined the proportion of ICH patients requiring unanticipated surgical evacuation and identified baseline factors associated with evacuation. Results: Among the 992 subjects analyzed, 44 (4.4%) subjects required unanticipated surgical evacuation of hematoma. The proportion of subjects with initial GCS score of 13 or less was significantly higher among those who required surgical evacuation (43.2% vs. 26.8%, P < 0.001). In the logistics regression analysis, hematoma volume ≥18 cm3 (odds ratio, 4.3; 95% confidence interval, 2.1–8.8) and right-sided hematoma (odds ratio, 2.8; 95% confidence interval, 1.3–5.9) were significantly associated with surgical evacuation. Age, location, GCS score strata, and allocated treatment (intensive vs. standard systolic blood pressure reduction) were not associated with surgical evacuation. Among the 44 patients who underwent surgical evacuation, death or disability at 3 months postrandomization was seen in 32 (73%) of 44 subjects. Conclusions: In the large cohort of ATACH 2 subjects with good grade ICH, the rates of unanticipated surgical evacuation were low and were associated with relatively high rates of death or disability at 3 months.
AB - Background: We performed this analysis to identify the rates, predictors, and associated outcomes of unexpected neurosurgical evacuation in a multicenter randomized clinical trial, Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) 2. Methods: The ATACH 2 trial determined the efficacy of antihypertensive treatment in patients with spontaneous supratentorial intracerebral hemorrhages (ICHs) with a Glasgow Coma Scale (GCS) score of ≥5 and intraparenchymal hematoma volume of <60 cm3 on initial computed tomographic scan. We determined the proportion of ICH patients requiring unanticipated surgical evacuation and identified baseline factors associated with evacuation. Results: Among the 992 subjects analyzed, 44 (4.4%) subjects required unanticipated surgical evacuation of hematoma. The proportion of subjects with initial GCS score of 13 or less was significantly higher among those who required surgical evacuation (43.2% vs. 26.8%, P < 0.001). In the logistics regression analysis, hematoma volume ≥18 cm3 (odds ratio, 4.3; 95% confidence interval, 2.1–8.8) and right-sided hematoma (odds ratio, 2.8; 95% confidence interval, 1.3–5.9) were significantly associated with surgical evacuation. Age, location, GCS score strata, and allocated treatment (intensive vs. standard systolic blood pressure reduction) were not associated with surgical evacuation. Among the 44 patients who underwent surgical evacuation, death or disability at 3 months postrandomization was seen in 32 (73%) of 44 subjects. Conclusions: In the large cohort of ATACH 2 subjects with good grade ICH, the rates of unanticipated surgical evacuation were low and were associated with relatively high rates of death or disability at 3 months.
KW - Intracerebral hemorrhage
KW - Mortality
KW - Neurologic deterioration
KW - Randomized clinical trial
KW - Surgical evacuation
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U2 - 10.1016/j.wneu.2020.06.089
DO - 10.1016/j.wneu.2020.06.089
M3 - Article
C2 - 32561489
AN - SCOPUS:85087959118
VL - 141
SP - e935-e940
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -