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• W2038354183 abstract "In the STICH II trial,1Mendelow AD Gregson BA Rowan EN Murray GD Gholkar A Mitchell PM for the STICH II InvestigatorsEarly surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial.Lancet. 2013; 382: 397-408Summary Full Text Full Text PDF PubMed Scopus (760) Google Scholar an absolute benefit of 3·7% in favourable outcome and 5·6% in mortality were reported for the early surgery group, but a significant difference between surgery and conservative treatment was not reached for the primary outcome.1Mendelow AD Gregson BA Rowan EN Murray GD Gholkar A Mitchell PM for the STICH II InvestigatorsEarly surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial.Lancet. 2013; 382: 397-408Summary Full Text Full Text PDF PubMed Scopus (760) Google Scholar Glasgow coma scale was the only scoring clinical indicator. Other stroke scales assessing clinical severity—ie, the National Institutes of Health scale, could be considered. Neurological severity, also in a conscious patient, is an important prognostic indicator. In the conservative treatment group more than 70% of patients (who were later treated surgically) had a paralysis in the limbs. Other possible indicators of poor outcome in lobar cerebral haemorrhage are previous ischaemic stroke, chronic obstructive pulmonary disease, chronic liver disease, and the use of anticoagulants and antiplatelets.2Arboix A Manzano C Garcia-Eroles L et al.Determinants of early outcome in spontaneous lobar cerebral hemorrhage.Acta Neurol Scand. 2006; 114: 187-192Crossref PubMed Scopus (11) Google Scholar Therefore, it might be useful to do a subanalysis of clinical and radiological outcomes (ie, rebleeding, volume increase) and considering patients taking anticoagulants and antiplatelets. Moreover, it would be interesting to analyse in the early surgery group if the clinical outcome might be dependent to time of intervention, similarly to thrombolysis in ischaemic strokes. As reported in some guidelines,3Morgenstern LB Hemphill 3rd, JC Anderson C et al.Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2010; 41: 2108-2129Crossref PubMed Scopus (1208) Google Scholar surgery might be indicated in lobar haemorrhages, but the timing is still a topic for debate and probably it should be personalised considering demographics, genetics,4Biffi A Anderson CD Jagiella JM et al.APOE genotype and extend of bleeding and outcome in lobar intracerebral haemorrhage: a genetic association study.Lancet Neurol. 2011; 10: 702-709Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar clinical features, comorbidities, and haematoma characteristics. We declare that we have no conflicts of interest. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trialThe STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage. Full-Text PDF Open AccessSurgery for cerebral haemorrhage—STICH II trial – Authors' replyWe welcome the opportunity to respond to the Correspondence on the STICH II trial.1 Full-Text PDF" @default.
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• W2038354183 date "2013-10-01" @default.
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• W2038354183 title "Surgery for cerebral haemorrhage—STICH II trial" @default.
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• W2038354183 doi "https://doi.org/10.1016/s0140-6736(13)62211-4" @default.
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