Minimally invasive ICH surgery evacuates clot fast but fails to improve 6-month outcomes

Editor's Note

Minimally invasive surgery (MIS) with the Artemis Neuro Evacuation Device reduced hematoma volume efficiently and lowered serious adverse events but did not improve long-term disability or mortality compared with medical management in spontaneous supratentorial intracerebral hemorrhage (ICH), JAMA Neurology September 2 reports.

The “MIND randomized clinical trial” enrolled 236 patients across 32 sites before stopping early after publication of a positive contemporaneous trial and a feasibility analysis. Participants were randomized almost 2:1 to surgery plus medical management (154 participants) or medical management alone (82 participants). Median age was 60 years, and most patients had hemorrhages—69.5% had primarily deep hemorrhages and 30.5% lobar. Surgery was performed within 72 hours, with a median of 27.5 hours from symptom onset among treated patients.

At 180 days, there was no difference in combined death and disability on the modified Rankin Scale (odds ratio 1.03; 96% CI 0.62–1.72; P=.45). Thirty-day mortality rates were similar, 7.2% in the surgery group versus 9.8% with medical care. Still, Artemis achieved an average 81% clot reduction, and 79% of patients had residual hematoma volumes under 15 mL. Serious adverse events through 180 days were less common after surgery (53% vs 68%). Exploratory analyses pointed to functional improvement at 30 days for both lobar and deep bleeds, but the effect disappeared by 90 and 180 days. The authors note the neutral results may reflect smaller hemorrhage volumes, later intervention timing, and trial stoppage that limited power.

The investigators conclude that Artemis provides safe and substantial clot evacuation with early signals of benefit, but further trials are needed to determine whether MIS can translate technical success into durable functional gains.