6 ISC NEWS DAY 2 | THURSDAY, FEBRUARY 6, 2025 StrokeConference.org #ISC25 Surgery with the ARTEMIS device shows shortterm benefit in patients with deep intracerebral hemorrhage Intracerebral hemorrhage accounts for 10% of all U.S. stroke cases per year but 30% to 40% of early stroke mortality. In the MIND study, researchers explored whether minimally invasive surgery with the ARTEMIS Neuro Evacuation Device could improve outcomes in patients primarily with deep and lobar intracerebral hemorrhages. The ARTEMIS tool uses neuro-navigation and an endoscope to visualize and evacuate the hemorrhage through a tiny endoscope sheath. Its low-profile access has the potential to minimize injury to surrounding brain tissue. MIND — a multicenter, openlabel, randomized trial — studied patients with moderate to large volume (20-80 cc) supratentorial intracerebral hemorrhage who presented within 24 hours of symptom onset. The patients were randomized 2:1 to minimally invasive surgery with the ARTEMIS device and medical management as defined by the American Heart Association/ American Stroke Association guidelines or to medical management alone. The study’s primary effectiveness endpoint was a 180-day ordinal modified Rankin score (mRS). The primary safety endpoint was 30-day mortality. Cases were stratified for severity and intracerebral hemorrhage location. The Early Minimally Invasive Removal of ICH (ENRICH) trial Late-breaking results from five trials presented at Opening Main Event At Wednesday’s Opening Main Event, researchers highlighted findings on minimally invasive surgery for intracerebral hemorrhage, transradial versus transfemoral angiography and outcomes of endovascular therapy for medium or distal vessel occlusion compared to medical management. The trials found: • Minimally invasive surgery for intracerebral hemorrhage did not improve longer-term patient outcomes. • Transradial angiography offers advantages over transfemoral angiography. • In patients receiving best medical treatment for medium or distal vessel occlusion, adding endovascular treatment did not reduce disability and death, the DISTAL trial found. • Endovascular therapy provided no added benefit over usual care, results from the ESCAPE-MeVO trial showed for medium vessel occlusion. • The DISCOUNT trial found mechanical thrombectomy wasn’t superior to usual care for treatment of distal vessel occlusion. recently demonstrated that minimally invasive surgery improves functional outcomes in patients with lobar intracerebral hemorrhage at 180 days. Based on a planned interim analysis, enrollment of patients with deep hemorrhages in the ENRICH trial was stopped early due to a lack of observed benefit in this subgroup, further underscoring the focus on patients with lobar hemorrhages. In the MIND study, enrollment was stopped after 236 patients, with 167 (70.8%) presenting with deep intracerebral hemorrhage and 72 (29.2%) with lobar intracerebral hemorrhage. After minimally invasive surgery, intracerebral hemorrhage volume was reduced by 81.5% to 6.0 cc in the deep and 80.4% to 8.1 cc in the lobar cohorts, respectively. Despite improvement in functional outcomes at 30 days in both cohorts, however, minimally invasive surgery with the ARTEMIS device was not superior to medical management only. “While minimally invasive surgery did not improve disability outcomes or reduce mortality at 180 days, we did see a substantial reduction in symptomatic perihematomal edema and improved modified Rankin scores at 30 days,” said MIND co-investigator David Fiorella, MD, PhD, director of the Cerebrovascular Center at Stony Brook University Hospital in New York. Fiorella also noted that fewer surgical patients were intubated, and they spent less time in the ICU and in the hospital at 30 days, compared with the medical management group. “Our data suggests that minimally invasive surgery is effective at eliminating or reducing early reversible intracerebral hemorrhage damage but can’t reverse enough of the persistent damage to maintain the significance,” he said. “But with limited treatment options for reducing disability at 30 days and getting patients out of the ICU or hospital earlier, the ARTEMIS procedure remains a viable option, particularly for patients with deep intracerebral hemorrhage.” Fiorella said significant advancements in our understanding of minimally invasive surgical techniques have been made since the MIND study began. The results of ongoing randomized clinical trials, like the Dutch ICH Surgery Trial, are likely to paint a clearer picture of whether endoscopic intracerebral hemorrhage evacuation improves long-term functional outcomes, he said. Transradial angiography offers better patientcentered outcomes compared with transfemoral angiography Although the transradial approach for cerebral angiography has gained popularity in recent years, evidence has been lacking regarding its efficacy and safety compared with the traditional transfemoral approach. The TRACE trial, a direct comparison of the efficacy and safety of the two approaches for cerebral angiography and neurointervention, found that the transradial approach provides notable advantages. TRACE is an investigatorinitiated, multicenter, open-label trial with blinded endpoint assessment. The trial randomized 858 patients scheduled for diagnostic cerebral angiography 1:1 to an intervention group (transradial angiography; 431 patients) or control group (transfemoral angiography; 427 patients). The study was conducted at 13 sites in China from September 2023 to November 2024. The primary endpoint, the success rate of diagnostic cerebral angiography, was lower in the transradial angiography group (91.0%, 392 patients) compared with Fiorella Ni
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