Clinical Trial

. 2019 Mar 9;393(10175):1021-1032.

doi: 10.1016/S0140-6736(19)30195-3. Epub 2019 Feb 7.

Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial

Daniel F Hanley¹, Richard E Thompson², Michael Rosenblum², Gayane Yenokyan², Karen Lane³, Nichol McBee³, Steven W Mayo⁴, Amanda J Bistran-Hall³, Dheeraj Gandhi⁵, W Andrew Mould³, Natalie Ullman⁶, Hasan Ali³, J Ricardo Carhuapoma⁷, Carlos S Kase⁸, Kennedy R Lees⁹, Jesse Dawson¹⁰, Alastair Wilson⁹, Joshua F Betz², Elizabeth A Sugar², Yi Hao³, Radhika Avadhani³, Jean-Louis Caron¹¹, Mark R Harrigan¹², Andrew P Carlson¹³, Diederik Bulters¹⁴, David LeDoux¹⁵, Judy Huang⁷, Cully Cobb¹⁶, Gaurav Gupta¹⁷, Ryan Kitagawa¹⁸, Michael R Chicoine¹⁹, Hiren Patel²⁰, Robert Dodd²¹, Paul J Camarata²², Stacey Wolfe²³, Agnieszka Stadnik²⁴, P Lynn Money²⁴, Patrick Mitchell²⁵, Rosario Sarabia²⁶, Sagi Harnof²⁷, Pal Barzo²⁸, Andreas Unterberg²⁹, Jeanne S Teitelbaum³⁰, Weimin Wang³¹, Craig S Anderson³², A David Mendelow³³, Barbara Gregson³³, Scott Janis³⁴, Paul Vespa³⁵, Wendy Ziai³, Mario Zuccarello³⁶, Issam A Awad²⁴; MISTIE III Investigators

Collaborators, Affiliations

Collaborators

MISTIE III Investigators:
Azmil Abdul-Rahim, Amal Abou-Hamden, Michael Abraham, Azam Ahmed, Carlos Alarcon Alba, E Francois Aldrich, David Altschul, Sepideh Amin-Hanjani, Doug Anderson, Safdar Ansari, David Antezana, Agnieszka Ardelt, Fuat Arikan, Marcelino Baguena, Alexandra Baker, Steven J Barrer, Kyra J Becker, Thomas Bergman, Azize Boström, Jamie Braun, Peter Brindley, William C Broaddus, Robert Brown, Andras Buki, Bing Cao, Ying Cao, Julian Carrion-Penagos, Julio Chalela, Tiffany Chang, Indalecio Moran Chorro, Shakeel Chowdhry, Luisa Corral, Laszlo Csiba, Jason Davies, Alberto Torres Díaz, Colin P Derdeyn, Michael Diringer, Rachel Dlugash, Robert Ecker, Tracey Economas, Pedro Enriquez, Erzsebet Ezer, Yuhua Fan, Hua Feng, Douglas Franz, W David Freeman, Matthew Fusco, Walter Galicich, Mary Leigh Gelea, Joshua Goldstein, Alejandro Carrasco Gonzalez, Christina Grabarits, Steven Greenberg, Daryl Gress, Eugene Gu, Christiana Hall, Fernando Muñoz Hernandez, Robert Hoesch, Brian L Hoh, Jennifer Houser, Rong Hu, Yi Huang, Mohammed Akbar Hussain, Salvatore Insinga, Ashutosh Jadhav, Jennifer Jaffe, Babak S Jahromi, Jack Jallo, Michael James, Robert F James, Brian Jankowitz, Esther Jeon, Draga Jichici, Karin Jonczak, Ben Jonker, Nicki Karlen, Naureen Keric, Thomas Kerz, Jared Knopman, Carolyn Koenig, Satish Krishnamurthy, Avinash Kumar, Inam Kureshi, John Laidlaw, Arun Lakhanpal, Julius Gene Latorre, Dana Leifer, James Leiphart, Sarah Lenington, Yunke Li, George Lopez, Darren Lovick, Christianto Lumenta, Jinbiao Luo, Matthew B Maas, Joel MacDonald, Larami MacKenzie, Vikram Madan, Ryan Majkowski, Otto Major, Rishi Malhorta, Marc Malkoff, Halinder Mangat, Ahmed Maswadeh, Charles Matouk, Kate McArthur, Scott McCaul, Joshua Medow, Geza Mezey, Janet Mighty, David Miller, Krishna K Mohan, Keith Muir, Lorenzo Muñoz, Peter Nakaji, Alex Nee, Saman Nekoovaght-Tak, Paul Nyquist, Roddy O'Kane, Mohamed Okasha, Cian O'Kelly, Noeleen Ostapkovich, Aditya Pandey, Adrian Parry-Jones, Krissia Rivera Perla, Ania Pollack, Sean Polster, Nader Pouratian, Terry Quinn, Ventatakrishna Rajajee, Kesava Reddy, Mohammed Rehman, Ronald Reimer, Fred Rincon, Igor Rybinnik, Baltasar Sanchez, Lauren Sansing, Michael Schneck, Ludwig Schuerer, David Schul, Jeffrey Schweitzer, David B Seder, Donald Seyfried, Kevin Sheth, Alejandro Spiotta, Michael Stechison, Katalin Szabo, Gonzalo Tamayo, Krisztian Tanczos, Philipp Taussky, John Terry, Fernando Testai, Kathrine Thomas, Carol B Thompson, Gregory Thompson, James C Torner, Huy Tran, Kristi Tucker, Lior Ungar, Panos Varelas, Nataly Montano Vargas, Hartmut Vatter, Chitra Venkatasubramanian, Krista Vermillion, Dennis Vollmer, Yan Wang, Ying Wang, Jiajun Wen, Louis Tony Whitworth, Byron Willis, Myriha Wrencher, Shawn E Wright, Yongge Xu, Lisa Yanase, Xuxia Yi, Zhiyuan Yu, Ali Zomorodi

Affiliations

¹ Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA. Electronic address: dhanley@jhmi.edu.
² Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
³ Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
⁴ Emissary International, Austin, TX, USA.
⁵ University of Maryland, Baltimore, MD, USA.
⁶ The Children's Hospital, Philadelphia, PA, USA.
⁷ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Emory University, Atlanta, GA, USA.
⁹ School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
¹⁰ Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
¹¹ University of Texas Health, San Antonio, TX, USA.
¹² University of Alabama, Birmingham, AL, USA.
¹³ University of New Mexico, Albuquerque, NM, USA.
¹⁴ University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁵ Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
¹⁶ Mercy Neurological Institute Stroke Center, Sacramento, California, USA.
¹⁷ Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
¹⁸ University of Texas, McGovern Medical Center, Houston, TX, USA.
¹⁹ Washington University School of Medicine, St Louis, MO, USA.
²⁰ Salford Royal Hospital, Salford, UK.
²¹ Stanford University School of Medicine, Stanford, California, USA.
²² University of Kansas, Kansas City, KS, USA.
²³ Wake Forest School of Medicine, Winston-Salem, NC, USA.
²⁴ University of Chicago, Chicago, IL, USA.
²⁵ Newcastle Royal Infirmary, Newcastle, UK.
²⁶ Hospital Universitario Rio Hortega, Valladolid, Spain.
²⁷ Rabin Medical Center, Petah Tikva, Israel.
²⁸ University of Szeged, Szeged, Hungary.
²⁹ University of Heidelberg, Heidelberg, Germany.
³⁰ Montreal Neurological Institute and Hospital at McGill University, Montreal, QC, Canada.
³¹ Guangzhou Neuroscience Institute, Guangzhou Liuhua Qiao Hospital, Guangzhou, China.
³² The George Institute for Global Health China at Peking University Health Science Center, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
³³ Newcastle University, Newcastle, UK.
³⁴ National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
³⁵ University of California, Los Angeles, CA, USA.
³⁶ University of Cincinnati, Cincinnati, OH, USA.

PMID: 30739747
PMCID: PMC6894906
DOI: 10.1016/S0140-6736(19)30195-3

Clinical Trial

Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial

Daniel F Hanley et al. Lancet. 2019.

. 2019 Mar 9;393(10175):1021-1032.

doi: 10.1016/S0140-6736(19)30195-3. Epub 2019 Feb 7.

Authors

Collaborators

MISTIE III Investigators:
Azmil Abdul-Rahim, Amal Abou-Hamden, Michael Abraham, Azam Ahmed, Carlos Alarcon Alba, E Francois Aldrich, David Altschul, Sepideh Amin-Hanjani, Doug Anderson, Safdar Ansari, David Antezana, Agnieszka Ardelt, Fuat Arikan, Marcelino Baguena, Alexandra Baker, Steven J Barrer, Kyra J Becker, Thomas Bergman, Azize Boström, Jamie Braun, Peter Brindley, William C Broaddus, Robert Brown, Andras Buki, Bing Cao, Ying Cao, Julian Carrion-Penagos, Julio Chalela, Tiffany Chang, Indalecio Moran Chorro, Shakeel Chowdhry, Luisa Corral, Laszlo Csiba, Jason Davies, Alberto Torres Díaz, Colin P Derdeyn, Michael Diringer, Rachel Dlugash, Robert Ecker, Tracey Economas, Pedro Enriquez, Erzsebet Ezer, Yuhua Fan, Hua Feng, Douglas Franz, W David Freeman, Matthew Fusco, Walter Galicich, Mary Leigh Gelea, Joshua Goldstein, Alejandro Carrasco Gonzalez, Christina Grabarits, Steven Greenberg, Daryl Gress, Eugene Gu, Christiana Hall, Fernando Muñoz Hernandez, Robert Hoesch, Brian L Hoh, Jennifer Houser, Rong Hu, Yi Huang, Mohammed Akbar Hussain, Salvatore Insinga, Ashutosh Jadhav, Jennifer Jaffe, Babak S Jahromi, Jack Jallo, Michael James, Robert F James, Brian Jankowitz, Esther Jeon, Draga Jichici, Karin Jonczak, Ben Jonker, Nicki Karlen, Naureen Keric, Thomas Kerz, Jared Knopman, Carolyn Koenig, Satish Krishnamurthy, Avinash Kumar, Inam Kureshi, John Laidlaw, Arun Lakhanpal, Julius Gene Latorre, Dana Leifer, James Leiphart, Sarah Lenington, Yunke Li, George Lopez, Darren Lovick, Christianto Lumenta, Jinbiao Luo, Matthew B Maas, Joel MacDonald, Larami MacKenzie, Vikram Madan, Ryan Majkowski, Otto Major, Rishi Malhorta, Marc Malkoff, Halinder Mangat, Ahmed Maswadeh, Charles Matouk, Kate McArthur, Scott McCaul, Joshua Medow, Geza Mezey, Janet Mighty, David Miller, Krishna K Mohan, Keith Muir, Lorenzo Muñoz, Peter Nakaji, Alex Nee, Saman Nekoovaght-Tak, Paul Nyquist, Roddy O'Kane, Mohamed Okasha, Cian O'Kelly, Noeleen Ostapkovich, Aditya Pandey, Adrian Parry-Jones, Krissia Rivera Perla, Ania Pollack, Sean Polster, Nader Pouratian, Terry Quinn, Ventatakrishna Rajajee, Kesava Reddy, Mohammed Rehman, Ronald Reimer, Fred Rincon, Igor Rybinnik, Baltasar Sanchez, Lauren Sansing, Michael Schneck, Ludwig Schuerer, David Schul, Jeffrey Schweitzer, David B Seder, Donald Seyfried, Kevin Sheth, Alejandro Spiotta, Michael Stechison, Katalin Szabo, Gonzalo Tamayo, Krisztian Tanczos, Philipp Taussky, John Terry, Fernando Testai, Kathrine Thomas, Carol B Thompson, Gregory Thompson, James C Torner, Huy Tran, Kristi Tucker, Lior Ungar, Panos Varelas, Nataly Montano Vargas, Hartmut Vatter, Chitra Venkatasubramanian, Krista Vermillion, Dennis Vollmer, Yan Wang, Ying Wang, Jiajun Wen, Louis Tony Whitworth, Byron Willis, Myriha Wrencher, Shawn E Wright, Yongge Xu, Lisa Yanase, Xuxia Yi, Zhiyuan Yu, Ali Zomorodi

Affiliations

¹ Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA. Electronic address: dhanley@jhmi.edu.
² Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
³ Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
⁴ Emissary International, Austin, TX, USA.
⁵ University of Maryland, Baltimore, MD, USA.
⁶ The Children's Hospital, Philadelphia, PA, USA.
⁷ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Emory University, Atlanta, GA, USA.
⁹ School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
¹⁰ Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
¹¹ University of Texas Health, San Antonio, TX, USA.
¹² University of Alabama, Birmingham, AL, USA.
¹³ University of New Mexico, Albuquerque, NM, USA.
¹⁴ University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁵ Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
¹⁶ Mercy Neurological Institute Stroke Center, Sacramento, California, USA.
¹⁷ Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
¹⁸ University of Texas, McGovern Medical Center, Houston, TX, USA.
¹⁹ Washington University School of Medicine, St Louis, MO, USA.
²⁰ Salford Royal Hospital, Salford, UK.
²¹ Stanford University School of Medicine, Stanford, California, USA.
²² University of Kansas, Kansas City, KS, USA.
²³ Wake Forest School of Medicine, Winston-Salem, NC, USA.
²⁴ University of Chicago, Chicago, IL, USA.
²⁵ Newcastle Royal Infirmary, Newcastle, UK.
²⁶ Hospital Universitario Rio Hortega, Valladolid, Spain.
²⁷ Rabin Medical Center, Petah Tikva, Israel.
²⁸ University of Szeged, Szeged, Hungary.
²⁹ University of Heidelberg, Heidelberg, Germany.
³⁰ Montreal Neurological Institute and Hospital at McGill University, Montreal, QC, Canada.
³¹ Guangzhou Neuroscience Institute, Guangzhou Liuhua Qiao Hospital, Guangzhou, China.
³² The George Institute for Global Health China at Peking University Health Science Center, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
³³ Newcastle University, Newcastle, UK.
³⁴ National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
³⁵ University of California, Los Angeles, CA, USA.
³⁶ University of Cincinnati, Cincinnati, OH, USA.

PMID: 30739747
PMCID: PMC6894906
DOI: 10.1016/S0140-6736(19)30195-3

Erratum in

Department of Error.
[No authors listed] [No authors listed] Lancet. 2019 Apr 20;393(10181):1596. doi: 10.1016/S0140-6736(19)30859-1. Lancet. 2019. PMID: 31007203 No abstract available.

Abstract

Background: Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and mortality. Open craniotomy haematoma evacuation has not been found to have any benefit in large randomised trials. We assessed whether minimally invasive catheter evacuation followed by thrombolysis (MISTIE), with the aim of decreasing clot size to 15 mL or less, would improve functional outcome in patients with intracerebral haemorrhage.

Methods: MISTIE III was an open-label, blinded endpoint, phase 3 trial done at 78 hospitals in the USA, Canada, Europe, Australia, and Asia. We enrolled patients aged 18 years or older with spontaneous, non-traumatic, supratentorial intracerebral haemorrhage of 30 mL or more. We used a computer-generated number sequence with a block size of four or six to centrally randomise patients to image-guided MISTIE treatment (1·0 mg alteplase every 8 h for up to nine doses) or standard medical care. Primary outcome was good functional outcome, defined as the proportion of patients who achieved a modified Rankin Scale (mRS) score of 0-3 at 365 days, adjusted for group differences in prespecified baseline covariates (stability intracerebral haemorrhage size, age, Glasgow Coma Scale, stability intraventricular haemorrhage size, and clot location). Analysis of the primary efficacy outcome was done in the modified intention-to-treat (mITT) population, which included all eligible, randomly assigned patients who were exposed to treatment. All randomly assigned patients were included in the safety analysis. This study is registered with ClinicalTrials.gov, number NCT01827046.

Findings: Between Dec 30, 2013, and Aug 15, 2017, 506 patients were randomly allocated: 255 (50%) to the MISTIE group and 251 (50%) to standard medical care. 499 patients (n=250 in the MISTIE group; n=249 in the standard medical care group) received treatment and were included in the mITT analysis set. The mITT primary adjusted efficacy analysis estimated that 45% of patients in the MISTIE group and 41% patients in the standard medical care group had achieved an mRS score of 0-3 at 365 days (adjusted risk difference 4% [95% CI -4 to 12]; p=0·33). Sensitivity analyses of 365-day mRS using generalised ordered logistic regression models adjusted for baseline variables showed that the estimated odds ratios comparing MISTIE with standard medical care for mRS scores higher than 5 versus 5 or less, higher than 4 versus 4 or less, higher than 3 versus 3 or less, and higher than 2 versus 2 or less were 0·60 (p=0·03), 0·84 (p=0·42), 0·87 (p=0·49), and 0·82 (p=0·44), respectively. At 7 days, two (1%) of 255 patients in the MISTIE group and ten (4%) of 251 patients in the standard medical care group had died (p=0·02) and at 30 days, 24 (9%) patients in the MISTIE group and 37 (15%) patients in the standard medical care group had died (p=0·07). The number of patients with symptomatic bleeding and brain bacterial infections was similar between the MISTIE and standard medical care groups (six [2%] of 255 patients vs three [1%] of 251 patients; p=0·33 for symptomatic bleeding; two [1%] of 255 patients vs 0 [0%] of 251 patients; p=0·16 for brain bacterial infections). At 30 days, 76 (30%) of 255 patients in the MISTIE group and 84 (33%) of 251 patients in the standard medical care group had one or more serious adverse event, and the difference in number of serious adverse events between the groups was statistically significant (p=0·012).

Interpretation: For moderate to large intracerebral haemorrhage, MISTIE did not improve the proportion of patients who achieved a good response 365 days after intracerebral haemorrhage. The procedure was safely adopted by our sample of surgeons.

Funding: National Institute of Neurological Disorders and Stroke and Genentech.

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Figures

**Figure 1:. Trial profile.**
*All randomly assigned patients (n=506) were included in safety analyses and sensitivity analyses. Loss to follow-up occurred when the patient could not be contacted. Withdrawal occurred when the patient or family refused to complete the planned follow-up. †Patients were randomly assigned in error and thus were excluded.

**Figure 2:. Independently adjudicated functional outcomes at 365 days post stroke in the modified intention-to-treat analysis set**
mRS scores range from 0 (no disability) to 6 (death); eGOS scores range from 8 (upper good recovery) to 1 (death). GR=good recovery. MD=moderate disability. SD=severe disability. VS=vegetative state. The proportion of 365-day mRS 0–3 was 110 (44.2%) in the MISTIE group vs 100 (41.7%) in the medical group. mRS 4–6 was 139 (55.8%) in the MISTIE group and 140 (58.3%) in the medical group. mRS scores were missing for 10 out of 499 patients; of the 10, 6 subjects were lost to follow-up, and 4 refused further participation in the study. The proportion of 365-day eGOS 4–8 (upper severe disability through upper good recovery) was 94 (38.5%) in the MISTIE group vs 84 (35.9%) in the medical group. eGOS scores 1–3 (lower severe disability through death) were 150 (61.5%) in the MISTIE group and 150 (64.1%) in the medical group. eGOS scores were missing for 21 out of 499 patients, out of which 11 completed the study with no eGOS reported, 6 were lost to follow-up, and 4 refused further participation. See appendix for detailed ordinal measures for mRS and eGOS.

**Figure 3:. Kaplan-Meier survival estimates from day of randomisation to observed day of death with truncation at day 365**
Estimated survival probabilities were higher throughout 365 days of follow-up with MISTIE compared to medical treatment (p=0.084). Shading shows 95% CI.

**Figure 4:. Subgroup analyses.**
Forest plot of interaction terms, adjusted for age, sex, race, intracerebral haemorrhage location, intracerebral haemorrhage stability, time from stroke to treatment initiation, and GCS score (mild, moderate, severe) at presentation. The test for homogeneity of treatment effect (based on testing for interaction) was not rejected at α level 0·05. The size of points indicates the relative sizes of the subgroups. GCS scores range from 15 (fully conscious) to 3 (deep coma). sICH=stability intracerebral haemorrhage. GCS=Glasgow Coma Scale.

See this image and copyright information in PMC

Comment in

Minimally invasive surgery plus alteplase for intracerebral haemorrhage.
Al-Shahi Salman R, Klijn CJM, Selim M. Al-Shahi Salman R, et al. Lancet. 2019 Mar 9;393(10175):965-967. doi: 10.1016/S0140-6736(19)30309-5. Epub 2019 Feb 7. Lancet. 2019. PMID: 30739746 No abstract available.
Surgery for intracerebral haemorrhage.
Engrand N, Mazighi M, Le Guerinel C, Dorison M, Dinkelacker V. Engrand N, et al. Lancet. 2019 Aug 24;394(10199):e20. doi: 10.1016/S0140-6736(19)31625-3. Lancet. 2019. PMID: 31448742 No abstract available.
Surgery for intracerebral haemorrhage.
Kolias AG, Marcus HJ, Broekman ML, Hutchinson PJ, McCulloch P. Kolias AG, et al. Lancet. 2019 Aug 24;394(10199):e21. doi: 10.1016/S0140-6736(19)31410-2. Lancet. 2019. PMID: 31448743 No abstract available.
Commentary: Efficacy and Safety of Minimally Invasive Surgery With Thrombolysis in Intracerebral Haemorrhage Evacuation (MISTIE III): A Randomized, Controlled, Open-Label, Blinded Endpoint Phase 3 Trial.
Sattur MG, Spiotta AM. Sattur MG, et al. Neurosurgery. 2020 May 1;86(5):E444-E446. doi: 10.1093/neuros/nyz551. Neurosurgery. 2020. PMID: 31960045 No abstract available.

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1. Hachinski V, Donnan GA, Gorelick PB, et al. Stroke: working toward a prioritized world agenda. Int J Stroke 2010; 5: 238–56. - PMC - PubMed
1. Cadilhac DA, Dewey HM, Vos T, Carter R, Thrift AG. The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS). Health Qual Life Outcomes 2010; 8: 49. - PMC - PubMed
1. Mayer SA, Brun NC, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2008; 358: 2127–37. - PubMed
1. Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365: 387–97. - PubMed

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Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial

Collaborators

Affiliations

Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial

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Erratum in

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