Post-Trial Enhanced Deployment and Technical Performance with the MISTIE Procedure per Lessons Learned

J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105996. doi: 10.1016/j.jstrokecerebrovasdis.2021.105996. Epub 2021 Jul 22.


Objective: We hypothesize that procedure deployment rates and technical performance with minimally invasive surgery and thrombolysis for intracerebral hemorrhage (ICH) evacuation (MISTIE) can be enhanced in post-trial clinical practice, per Phase III trial results and lessons learned.

Materials and methods: We identified ICH patients and those who underwent MISTIE procedure between 2017-2021 at a single site, after completed enrollments in the Phase III trial. Deployment rates, complications and technical outcomes were compared to those observed in the trial. Initial and final hematoma volume were compared between site measurements using ABC/2, MISTIE trial reading center utilizing manual segmentation, and a novel Artificial Intelligence (AI) based volume assessment.

Results: Nineteen of 286 patients were eligible for MISTIE. All 19 received the procedure (6.6% enrollment to screening rate 6.6% compared to 1.6% at our center in the trial; p=0.0018). Sixteen patients (84%) achieved evaculation target < 15 mL residual ICH or > 70% removal, compared to 59.7% in the trial surgical cohort (p=0.034). No poor catheter placement occurred and no surgical protocol deviations. Limitations of ICH volume assessments using the ABC/2 method were shown, while AI based methodology of ICH volume assessments had excellent correlation with manual segmentation by experienced reading centers.

Conclusions: Greater procedure deployment and higher technical success rates can be achieved in post-trial clinical practice than in the MISTIE III trial. AI based measurements can be deployed to enhance clinician estimated ICH volume. Clinical outcome implications of this enhanced technical performance cannot be surmised, and will need assessment in future trials.

Keywords: Intracerebral hemorrhage; Intracranial hemorrhage; MISTIE, Artificial intelligence.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Artificial Intelligence
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / therapy*
  • Clinical Trials, Phase III as Topic
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures* / adverse effects
  • Predictive Value of Tests
  • Radiographic Image Interpretation, Computer-Assisted
  • Retrospective Studies
  • Thrombolytic Therapy* / adverse effects
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome