Chapter

Brain Edema XIII

Volume 96 of the series Acta Neurochirurgica Supplementum pp 61-64

The significance of crossovers after randomization in the STICH trial

  • K. S. M. PrasadAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
  • , B. A. GregsonAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
  • , P. S. BhattathiriAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
  • , P. MitchellAffiliated withRegional Neurosciences Centre, Newcastle General Hospital
  • , A. D. MendelowAffiliated withRegional Neurosciences Centre, Newcastle General HospitalDepartment of Neurosurgery, Newcastle General Hospital

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Summary

Introduction

Of all forms of stroke, spontaneous intracerebral haemorrhage (ICH) causes the highest morbidity and mortality. The Surgical Trial in Intracerebral Haemorrhage (STICH) found no difference in outcomes between patients randomized to surgical or conservative treatment.

Patients and methods

Of 530 patients randomized to initial conservative treatment, 140 crossed over to surgery. This study examines the variables associated with crossover.

Results

Dominant features of the crossover group were: male, (p = 0.04), right-sided clot (p = 0.03), lobar clot (p = 0.003), clot volume (median 64 mL for crossovers vs. 38 mL for others, p < 0.00001), midline shift (median 6 mm for crossovers vs. 3 mm for others, p > 0.00001), superficial clot (median 1.3 mm for cross-overs vs. 11.5 mm for others, p < 0.00001), and randomization within 12 hours of ictus (p < 0.0005). Thalamic location (p = 0.002) was under-represented. Intraventricular haemorrhage, hydrocephalus, and focal deficits were not associated with crossover. Craniotomy was the method of evacuation in 85% of crossover patients.

Conclusions

Crossover to surgery was more likely when ICH had these features: Right side, lobar location, superficial, large volume, big shift, and early randomization. Crossovers formed a worse prognostic group compared to non-crossovers. Surgery did not affect trial results, which were analyzed by intention-to-treat.

Keywords

Crossover intracerebral haemorrhage surgery