Article Figures & Data
- Figure 1
Flowchart of patients from MISTIE III trial. MIS, minimally invasive surgery; MISTIE III, phase III minimally invasive surgery plus alteplase for intracerebral haemorrhage evacuation.
- Figure 2
Prespecified adjusted subgroup analyses of odds of poor functional outcome at 1 year by brain MRI features for (A) full cohort, (B) MIS, (C) EOT volume ≤15 mL and (D) standard medical care (medical) group. All analyses were adjusted for age, admission GCS, diagnostic ICH volume, IVH present at diagnosis, lobar ICH location, diabetes and admission systolic blood pressure. BG, basal ganglia; CAA, cerebral amyloid angiopathy; CMB, cerebral microbleed; CSS, cortical superficial siderosis; CSVD, cerebral small vessel disease; EOT, end-of-treatment; EPVS, enlarged perivascular spaces; GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; IVH, intraventricular haemorrhage; mCSVD, modified CSVD; MIS, minimally invasive surgery.
- Figure 3
Pre-specified adjusted subgroup analysis of the odds of poor functional outcome at 1 year by brain MRI features comparing (A) MIS versus SMC, (B) EOT volume≤15 mL versus SMC and (C) EOT volume≤15 mL versus EOT volume>15 mL. All analyses were adjusted for age, admission GCS, diagnostic ICH volume, IVH present at diagnosis, lobar ICH location, diabetes and admission systolic blood pressure. BG, basal ganglia; CAA, cerebral amyloid angiopathy; CMB, cerebral microbleed; CSS, cortical superficial siderosis; CSVD, cerebral small vessel disease; EOT, end-of-treatment; EPVS, enlarged perivascular spaces; GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; IVH, intraventricular haemorrhage; mCSVD, modified CSVD; MIS, minimally invasive surgery.
- Figure 4
mRS score distribution by CAA score 0–1 versus 2–6 in (A) full MRI cohort (n=288), (B) MIS (n=149) versus medical (n=139) groups and (C) EOT volume≤15 mL (n=94) versus>15 mL (n=194). mRS scores range from 0 (no disability) to 6 (death). P values are for odds of mRS 0–3 versus 4–6 for CAA score 0–1 versus 2–6 in analyses adjusted for age, admission GCS, diagnostic ICH volume, IVH present at diagnosis, lobar ICH location, diabetes and admission systolic blood pressure. CAA, cerebral amyloid angiopathy; CSVD, cerebral small vessel disease; EOT, end-of-treatment; GCS, Glasgow Coma Scale; ICH, intracerebral haemorrhage; IVH, intraventricular haemorrhage; mCSVD, modified CSVD; MIS, minimally invasive surgery; mRS modified Rankin Score.
- Table 1
Baseline characteristics of participants in the MRI substudy
Standard medical care (n=139) MISTIE (n=149) EOT volume ≤15 mL (n=94) Sex, number (%) Male 85 (61) 89 (60) 56 (60) Female 56 (39) 60 (40) 38 (40) Age, median (IQR), years 62 (52–71) 62 (52–68) 63 (52–69) Hypertension, number (%) 137 (99) 143 (96) 92 (98) Diabetes, number (%) 45 (32) 45 (30) 27 (29) Coronary artery disease, number (%) 17 (12) 23 (17) 13 (14) Anticoagulant use, number (%) 4 (3) 15 (10) 4 (4) Antiplatelet use, number (%) 52 (37) 44 (30) 28 (30) Current smoker, number (%) 19 (14) 37 (25) 25 (27) Alcohol abuse, number (%) 12 (9) 26 (17) 13 (14) Baseline CT and clinical factors Diagnostic ICH volume, median (IQR), mL 40.5 (30.8–54.9) 42.2 (30.7–51.3) 36.8 (29.3–49.6) Diagnostic IVH volume, median (IQR), mL 0 (0–1.8) 0 (0–1.6) 0 (0–1.1) IVH present at diagnosis, number (%) 57 (41) 57 (38) 32 (34) Lobar haematoma, number (%) 58 (42) 54 (36) 30 (32) GCS at randomisation, median (IQR) 10 (8–13) 10 (8–13) 10 (8–13) Systolic blood pressure, median (IQR), mm Hg 180 (160–202) 181 (155–208) 180 (149–213) Diastolic blood pressure, median (IQR), mm Hg 98 (84–119) 98 (84–115) 98 (84–115) Mean arterial pressure at first 24 hours, median (IQR) 92 (83–98) 92 (86–97) 93 (86–98) Surgical group, number (%) 0 149 (100) 91 (97) EOT CT ICH volume ≤15 mL, number (%) 3 (2) 91 (61) 94 (100) EOT, end-of-treatment; GCS, glasgow coma scale; ICH, intracerebral haemorrhage; INR, international normalised ratio; IVH, intraventricular haemorrhage; MISTIE, minimally invasive surgery plus alteplase for intracerebral haemorrhage evacuation; PTT, partial thromboplastin time.
- Table 2
Comparison of cerebral small vessel disease (CSVD) features and CSVD burden scores between outcome groups
Full cohort, number (%) (n=288) Entire cohort
(n=288)Favourable outcome
(n=127)Unfavourable outcome (n=161) P value Presence of lacunes 26 (9) 8 (6) 18 (11) 0.21 Lobar lacunes 9 (3) 4 (3) 5 (3) 1.00 Deep lacunes 17 (6) 4 (3) 13 (8) 0.13 Presence of CMBs 118 (41) 45 (35) 73 (45) 0.09 Deep CMBs 0.06 0 214 (74) 102 (80) 112 (70) 1 31 (11） 16 (13） 15 (9） 2–4 20 (7） 6 (5） 14 (9） 5–10 22 (8） 7 (6） 15 (9） >10 5 (2） 0 (0） 5 (3） Lobar CMBs 0.16 0 196 (68) 92 (72) 104 (65) 1 31 (11) 16 (13) 15 (9) 2–4 20 (7) 6 (5) 14 (9) 5–10 30 (10) 11 (9) 19 (12) >10 11 (4) 2 (2) 9 (6) Total CMBs 0.19 0 170 (59) 82 (65) 88 (55) 1 32 (11) 16 (13) 16 (10) 2–4 25 (11) 10 (8) 15 (9) 5–10 39 (14) 13 (10) 26 (16) >10 22 (8) 6 (5) 16 (10) CMBs≥5 61 (21) 19 (15) 42 (26) 0.03 Number of EPVS in BG 0.08 0 24 (8) 14 (11) 10 (6) 1–10 98 (34) 50 (39) 48 (30) 11–20 68 (24) 30 (24) 38 (24) 21–40 74 (26) 26 (21) 48 (30) >40 24 (8) 7 (6) 17 (11) Number of EPVS in CSO 0.59 0 41 (14) 19 (15) 22 (14) 1–10 61 (21) 27 (21) 34 (21) 11–20 50 (17) 17 (13) 33 (21) 21–40 74 (26) 36 (28) 38 (24) >40 62 (22) 28 (22) 34 (21) Severe EPVS in BG 166 (58) 63 (50) 103 (64) 0.02 Deep Fazekas score <0.001 0 82 (29) 49 (39) 33 (21) 1 129 (45) 62 (49) 67 (42) 2 60 (21) 13 (10) 47 (29) 3 17 (6) 3 (2) 14 (9) Periventricular Fazekas score <0.001 0 6 (2) 6 (5) 0 1 133 (46) 79 (62) 54 (34) 2 98 (34) 33 (26) 65 (40) 3 51 (18) 9 (7) 42 (26) Total Fazekas score <0.001 0 6 (2) 6 (5) 0 1 64 (22) 36 (28) 28 (17) 2 71 (25) 47 (37) 24 (15) 3 65 (23) 22 (17) 43 (27) 4 46 (16) 10 (8) 36 (22) 5 19 (7) 3 (2) 16 (10) 6 17 (6) 3 (2) 14 (9) Severe WMH 147 (51) 38 (30) 109 (68) <0.001 Presence of cSS 38 (13) 9 (7) 27 (17) 0.02 Focal (≤3 sulci) 36 (13) 9 (18) 25 (16) Disseminated (≥4 sulci) 2 (1) 0 2 (1) CSVD score <0.001 0 56 (19) 39 (31) 17 (11) 1 80 (27) 42 (33) 38 (24) 2 89 (31) 28 (22) 59 (37) 3 57 (20) 16 (13) 41 (25) 4 8 (3) 2 (1) 6 (3) CAA score <0.001 0 98 (34) 66 (52) 32 (20) 1 82 (29) 29 (23) 53 (33) 2 53 (18) 20 (16) 33 (21) 3 32 (11) 9 (7) 23 (14) 4 21 (7) 3 (2) 18 (11) 5 2 (1) 0 2 (1) 6 0 0 0 Modified CSVD score <0.001 0 60 (21) 43 (34) 17 (11) 1 91 (31) 46 (36) 44 (27) 2 84 (29) 25 (20) 58 (36) 3 41 (14) 11 (9) 30 (19) 4 13 (5) 2 (1) 11 (7) 5 1 (0) 0 (0) 1 (0) Severe EPVS=grade 3 (21–40) and 4 (>40).
BG, basal ganglia; CAA, cerebral amyloid angiopathy; CMB, cerebral microbleeds; CSO, centrum semiovale; cSS, cortical superficial siderosis; CSVD, cerebral small vessel disease; EPVS, enlarged perivascular spaces; WMH, white matter hyperintensities.
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