Minimally Invasive Surgery vs Medical Management Alone in Individuals with Supratentorial ICH

According to results from the MIND clinical trial (NCT03342664) published in JAMA Neurology, minimally invasive surgery within 72 hours using the Artemis Neuro Evacuation Device (Penumbra, Alameda, CA) did not significantly improve 6-month disability or reduce 30-day mortality compared with medical management alone in patients with supratentorial intracerebral hemorrhage (ICH).

The open-label, multicenter trial included 236 adult patients aged 18 to 80 years with moderate-to-large spontaneous supratentorial ICH (20 mL to 80 mL in volume), a baseline National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher, and a Glasgow Coma Scale (GCS) score between 5 and 15. Participants were randomized 2:1 to receive either minimally invasive surgery within 72 hours of symptom onset plus medical management or medical management alone.

Key findings from the study include the following:

• There was no significant difference in death or disability at 180 days between the surgery plus medical management group and the medical management alone group (odds ratio [OR] 1.03; 96% CI, 0.62 to 1.72; P=.45)
• 30-day mortality was 7.2% for participants (n=11) in the surgery plus medical management group vs 9.8% in the medical management group (n=8) (difference, −2.5%; 95% CI, −11.7% to 4.8%)

Source: Arthur AS, Jahromi BS, Saphier PS, et al. Minimally invasive surgery vs medical management alone for intracerebral hemorrhage: the MIND randomized clinical trial. JAMA Neurol. 2025;82(11):1113–1121. doi:10.1001/jamaneurol.2025.3151