Journal
NEUROTHERAPEUTICS
Volume 16, Issue 3, Pages 891-900Publisher
SPRINGER
DOI: 10.1007/s13311-019-00722-7
Keywords
Spontaneous intracerebral hemorrhage; neuroendoscopy; craniotomy; subsequent vascular risk; stroke; mortality
Funding
- China Medical University Hospital [DMR-105-054]
- Taiwan Ministry of Health and Welfare Clinical Trial Center [MOHW108-TDU-B-212-133004]
- Academia Sinica Stroke Biosignature Project [BM10701010021]
- MOST Clinical Trial Consortium for Stroke [MOST 107-2321-B-039-004]
- Tseng-Lien Lin Foundation, Taichung, Taiwan
- Katsuzo and Kiyo Aoshima Memorial Funds, Japan
- Chinese Medicine Research Center, China Medical University, from the Featured Areas Research Center Program by the Ministry of Education (MOE) in Taiwan [CMRC-CMA-7]
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Debates regarding the most beneficial medical or surgical procedures for patients with spontaneous intracerebral hemorrhage (sICH) are still ongoing. We aimed to evaluate the risk of subsequent vascular disease and mortality in patients with sICH treated with and without surgical intervention, in a large-scale Asian population. Patients hospitalized within 2000 to 2013 who were newly diagnosed with sICH were identified using the National Health Insurance Research Database of Taiwan. Neuroendoscopy and craniotomy groups comprised patients who underwent surgical treatment within 1 week, while those in the control group did not undergo early surgical treatment. Outcomes included subsequent hemorrhagic and ischemic stroke, following acute myocardial infarction, congestive heart failure, and mortality. After propensity score matching, there were 663 patients in each group. Compared to that in the control group, the neuroendoscopy and craniotomy groups had a significantly higher risk of secondary vascular events at 1 to 3 months of follow-up (adjusted HR, 2.08 and 1.95; 95% CI, 1.21-3.58 and 1.13-3.35; p < 0.01 and p < 0.05, respectively), but a significantly lower risk after 3 years of follow-up (adjusted HR, 0.52 and 0.52; 95% CI, 0.35-0.78 and 0.35-0.77; p < 0.01 and p < 0.01, respectively). The mortality rate was higher in the craniotomy group at 6 to 12 months of follow-up (adjusted HR, 2.18; 95% CI, 1.06-4.49; p < 0.05) compared to that in the control group. Thus, a timely surgical intervention for hematoma evacuation is advantageous in preventing secondary vascular events and improving outcomes in the long term. However, greater attention to secondary ischemic stroke following the initial sICH episode is needed.
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