Evidence map›Paper›PMID 30943878›Full record

Trial reportInternational journal of stroke : official journal of the International Stroke Society2019

A randomized 500-subject open-label phase 3 clinical trial of minimally invasive surgery plus alteplase in intracerebral hemorrhage evacuation (MISTIE III).

Wendy C Ziai, Nichol McBee, Karen Lane, Kennedy R Lees, Jesse Dawson, Paul Vespa, Richard E Thompson, A David Mendelow, Carlos S Kase, J Ricardo Carhuapoma and 12 more

Open access · greenAbstract readClinical Trial, Phase IIIMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in International journal of stroke : official journal of the International Stroke Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
2.8field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.

  1. Surgery for spontaneous supratentorial intracerebral haemorrhage.The Cochrane database of systematic reviews · 2025
    Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Review
  6. Article
  7. Article
  8. Minimally invasive puncture combined with a high frequency of urokinase therapy improves outcomes in patients with HICH.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2024
    Article
  9. Article
  10. Review
  11. Article
  12. When the Blood Hits Your Brain: The Neurotoxicity of Extravasated Blood.International journal of molecular sciences · 2021
    Review
  13. Article
  14. Article
  15. Article
  16. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 13 institutions in 4 countries.

Wendy C Ziai1 Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Nichol McBee2 Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
Karen Lane2 Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
Kennedy R Lees3 School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Jesse Dawson4 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Paul Vespa5 Department of Neurosurgery, University of California, Los Angeles, CA, USA.
Richard E Thompson6 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
A David Mendelow7 Department of Neurosurgery, Newcastle University, Newcastle upon Tyne, UK.
Carlos S Kase8 Department of Neurology, Emory University, Atlanta, GA, USA.
J Ricardo Carhuapoma1 Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Carol B Thompson9 Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Steven W Mayo10 Emissary International LLC, Austin, TX, USA.
Pat Reilly11 Genentech Inc., San Francisco, CA, USA (retired).
Scott Janis13 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
Craig S Anderson14 The George Institute for Global Health China at Peking University Health Science Center, Beijing, China.
Mark R Harrigan16 Department of Neurosurgery, University of Alabama, Birmingham, AL, USA.
Paul J Camarata17 Department of Neurosurgery, University of Kansas, Kansas City, KS, USA.
Jean-Louis Caron18 Department of Neurosurgery, University of Texas, San Antonio, TX, USA.
Mario Zuccarello19 Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA.
Issam A Awad20 Section of Neurosurgery, Neurovascular Surgery Program, University of Chicago, Chicago, IL, USA.
Daniel F Hanley2 Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA.
MISTIE III Investigators
Johns Hopkins University · USJohns Hopkins Medicine · USUniversity of Glasgow · GBEmory University · USNational Institute of Neurological Disorders and Stroke · USNewcastle University · GBThe George Institute for Global Health · AUThe University of Texas at San Antonio · USUniversity of Alabama at Birmingham · USUniversity of California, Los Angeles · USUniversity of Chicago · USUniversity of Cincinnati · USUniversity of Kansas · US

Funding

MISTIE III_ Lead Grant_ Cluster Application for the Clinical Coordinating CenterU01NS080824 · NINDS · JOHNS HOPKINS UNIVERSITY · PI HANLEY, DANIEL F · 2013 to 2017
$23.2M
NINDS NIH HHS U01 NS080824
6 · The paper itself

Abstract

rationale and hypothesisSurgical removal of spontaneous intracerebral hemorrhage may reduce secondary destruction of brain tissue. However, large surgical trials of craniotomy have not demonstrated definitive improvement in clinical outcomes. Minimally invasive surgery may limit surgical tissue injury, and recent evidence supports testing these approaches in large clinical trials. METHODS AND

designMISTIE III is an investigator-initiated multicenter, randomized, open-label phase 3 study investigating whether minimally invasive clot evacuation with thrombolysis improves functional outcomes at 365 days compared to conservative management. Patients with supratentorial intracerebral hemorrhage clot volume ≥ 30 mL, confirmed by imaging within 24 h ofknown symptom onset,and intact brainstem reflexes were screened with a stability computed tomography scan at least 6 h after diagnostic scan. Patients who met clinical and imaging criteria (no ongoing coagulopathy; no suspicion of aneurysm, arteriovenous malformation, or any other vascular anomaly; and stable hematoma size on consecutive scans) were randomized to either minimally invasive surgery plus thrombolysis or medical therapy. The sample size of 500 was based on findings of a phase 2 study. STUDY OUTCOMES: The primary outcome measure is dichotomized modified Rankin Scale 0-3 vs. 4-6 at 365 days adjusting for severity variables. Clinical secondary outcomes include dichotomized extended Glasgow Outcome Scale and all-cause mortality at 365 days; rate and extent of parenchymal blood clot removal; patient disposition at 365 days; efficacy at 180 days; type and intensity of ICU management; and quality of life measures. Safety was assessed at 30 days and throughout the study.

Indexed as

AdolescentAdultCerebral HemorrhageCombined Modality TherapyComputed Tomography AngiographyFemaleFibrinolytic AgentsHumansMaleMinimally Invasive Surgical ProceduresSingle-Blind MethodTissue Plasminogen ActivatorTreatment OutcomeYoung AdultFibrinolytic AgentsTissue Plasminogen Activatorintracerebral hemorrhageminimally invasive surgeryprotocolsRandomized controlled trialstrokesurgerythrombolysis

Identifiers

PMID30943878
PMCPMC6706298
OpenAlexW2926591995

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.