Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trial
BACKGROUND: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compa...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
May 15, 2024
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| In: |
The lancet
Year: 2024, Volume: 403, Issue: 10442, Pages: 2395-2404 |
| ISSN: | 1474-547X |
| DOI: | 10.1016/S0140-6736(24)00702-5 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/S0140-6736(24)00702-5 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0140673624007025 
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| Author Notes: | Jürgen Beck, Christian Fung, Daniel Strbian, Lukas Bütikofer, Werner J. Z'Graggen, Matthias F. Lang, Seraina Beyeler, Jan Gralla, Florian Ringel, Karl Schaller, Nikolaus Plesnila, Marcel Arnold, Werner Hacke, Peter Jüni, Alexander David Mendelow, Christian Stapf, Rustam Al-Shahi Salman, Jenny Bressan, Stefanie Lerch, Arsany Hakim, Nicolas Martinez-Majander, Anna Piippo-Karjalainen, Peter Vajkoczy, Stefan Wolf, Gerrit A. Schubert, Anke Höllig, Michael Veldeman, Roland Roelz, Andreas Gruber, Philip Rauch, Dorothee Mielke, Veit Rohde, Thomas Kerz, Eberhard Uhl, Enea Thanasi, Hagen B. Huttner, Bernd Kallmünzer, L. Jaap Kappelle, Wolfgang Deinsberger, Christian Roth, Robin Lemmens, Jan Leppert, Jose L. Sanmillan, Jonathan M. Coutinho, Katharina A.M. Hackenberg, Gernot Reimann, Mikael Mazighi, Claudio L.A. Bassetti, Heinrich P. Mattle, Andreas Raabe, Urs Fischer on behalf of the SWITCH study investigators |
MARC
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| 245 | 1 | 0 | |a Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage |b a randomised controlled clinical trial |c Jürgen Beck, Christian Fung, Daniel Strbian, Lukas Bütikofer, Werner J. Z'Graggen, Matthias F. Lang, Seraina Beyeler, Jan Gralla, Florian Ringel, Karl Schaller, Nikolaus Plesnila, Marcel Arnold, Werner Hacke, Peter Jüni, Alexander David Mendelow, Christian Stapf, Rustam Al-Shahi Salman, Jenny Bressan, Stefanie Lerch, Arsany Hakim, Nicolas Martinez-Majander, Anna Piippo-Karjalainen, Peter Vajkoczy, Stefan Wolf, Gerrit A. Schubert, Anke Höllig, Michael Veldeman, Roland Roelz, Andreas Gruber, Philip Rauch, Dorothee Mielke, Veit Rohde, Thomas Kerz, Eberhard Uhl, Enea Thanasi, Hagen B. Huttner, Bernd Kallmünzer, L. Jaap Kappelle, Wolfgang Deinsberger, Christian Roth, Robin Lemmens, Jan Leppert, Jose L. Sanmillan, Jonathan M. Coutinho, Katharina A.M. Hackenberg, Gernot Reimann, Mikael Mazighi, Claudio L.A. Bassetti, Heinrich P. Mattle, Andreas Raabe, Urs Fischer on behalf of the SWITCH study investigators |
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| 520 | |a BACKGROUND: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compared to best medical treatment alone. METHODS: In this multicentre, randomised, open-label, assessor-blinded trial conducted in 42 stroke centres in Austria, Belgium, Finland, France, Germany, the Netherlands, Spain, Sweden, and Switzerland, adults (18-75 years) with a severe intracerebral haemorrhage involving the basal ganglia or thalamus were randomly assigned to receive either decompressive craniectomy plus best medical treatment or best medical treatment alone. The primary outcome was a score of 5-6 on the modified Rankin Scale (mRS) at 180 days, analysed in the intention-to-treat population. This trial is registered with ClincalTrials.gov, NCT02258919, and is completed. FINDINGS: SWITCH had to be stopped early due to lack of funding. Between Oct 6, 2014, and April 4, 2023, 201 individuals were randomly assigned and 197 gave delayed informed consent (96 decompressive craniectomy plus best medical treatment, 101 best medical treatment). 63 (32%) were women and 134 (68%) men, the median age was 61 years (IQR 51-68), and the median haematoma volume 57 mL (IQR 44-74). 42 (44%) of 95 participants assigned to decompressive craniectomy plus best medical treatment and 55 (58%) assigned to best medical treatment alone had an mRS of 5-6 at 180 days (adjusted risk ratio [aRR] 0·77, 95% CI 0·59 to 1·01, adjusted risk difference [aRD] -13%, 95% CI -26 to 0, p=0·057). In the per-protocol analysis, 36 (47%) of 77 participants in the decompressive craniectomy plus best medical treatment group and 44 (60%) of 73 in the best medical treatment alone group had an mRS of 5-6 (aRR 0·76, 95% CI 0·58 to 1·00, aRD -15%, 95% CI -28 to 0). Severe adverse events occurred in 42 (41%) of 103 participants receiving decompressive craniectomy plus best medical treatment and 41 (44%) of 94 receiving best medical treatment. INTERPRETATION: SWITCH provides weak evidence that decompressive craniectomy plus best medical treatment might be superior to best medical treatment alone in people with severe deep intracerebral haemorrhage. The results do not apply to intracerebral haemorrhage in other locations, and survival is associated with severe disability in both groups. FUNDING: Swiss National Science Foundation, Swiss Heart Foundation, Inselspital Stiftung, and Boehringer Ingelheim. | ||
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| 650 | 4 | |a Aged | |
| 650 | 4 | |a Cerebral hemorrhage | |
| 650 | 4 | |a Combined modality therapy | |
| 650 | 4 | |a Decompressive craniectomy | |
| 650 | 4 | |a Female | |
| 650 | 4 | |a Humans | |
| 650 | 4 | |a Male | |
| 650 | 4 | |a Middle aged | |
| 650 | 4 | |a Treatment outcome | |
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