Abstract WMP105: Time is Brain Following Ich: Time to Evacuation Impacts Functional Outcome After Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Abstract

Introduction: Preclinical data have demonstrated a time-dependent benefit to early intracerebral hemorrhage (ICH) evacuation while clinical data have been less clear. Here we present long term functional outcome after minimally invasive endoscopic intracerebral hemorrhage evacuation with a focus on time to evacuation (TTE). Methods: Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit prespecified clinical inclusion and exclusion criteria agreed upon by a multidisciplinary group of physicians in the health care system. Retrospective analysis of prospectively collected data was performed on patients who were treated from December 2015 to October 2018. Demographic, clinical, and radiographic factors previously demonstrated to impact functional outcome in ICH were included in a multivariate logistic regression to identify factors predicting favorable outcome (modified Rankin Scale 0-3) at 6 months post-hemorrhage. Results: Ninety patients underwent MIS endoscopic ICH evacuation within 72 hours of ictus. In a multivariate analysis, factors that were identified to predict a positive outcome included age (per decade, OR 0.48, 95% CI 0.28-0.82) presence of intraventricular hemorrhage (OR 0.23, 95% CI 0.07-0.79), cortical location (OR 19.89, 95% CI 3.37-117.39), early evacuation (per hour, OR 0.95, 95% CI 0.92-0.99). Patients who underwent evacuation within 24 hours were 5 times more likely to achieve a favorable outcome (OR 5.29, 95% CI 1.52-18.41). Early evacuation did not correlate with increased risk of rebleeding. Conclusion: Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every one hour evacuation is delayed results in a 5% reduction in the odds of achieving a favorable long-term outcome.