2019 AMI Online Salon

Minimally Invasive Surgery Plus Thrombolysis for Intracerebral Hemorrhage Evacuation (MISTIE)

Project Details

  • Company/Institution: Johns Hopkins University, School of Medicine
  • Entrant Name: Jennifer Fairman
  • Membership Type: Professional Submission
  • Address: Ellicott City, MD
  • Client: Issam A Awad, MD, Daniel F Hanley, MD, MISTIE III Trial Investigators
  • Medium/software used: Graphite Pencil, Adobe Photoshop and Illustrator, HOROS
  • Final presentation format: Journal Cover for Neurosurgery
  • Primary Audience: Neurosurgeons

Project Description

To illustrate a minimally invasive neurosurgical procedure using stereotactic catheter aspiration and clearance of supratentorial intracerebral hemorrhage (ICH), a morbid and disabling type of stroke. This cover shows a frontal trajectory placement of a Minimally Invasive Surgery plus Thrombolysis for Intracerebral Hemorrhage Evacuation (MISTIE) catheter, allowing evacuation of the ICH through a very small craniotomy.

Image guided aspiration is conducted via a rigid cannula, followed by placement of a soft drainage catheter (shown) in the epicenter of the hematoma. The catheter is secured to the scalp with several interrupted sutures. Recombinant Tissue Plasminogen Activator is administered through the catheter to dissolve the clot. The subsequent shrinking clot volume is depicted.

This study, a first to define thresholds for ICH blood volume reduction, showed an average of 70% evacuation was consistent for survival benefit with good functional outcome after 1 year.