====== ARTEMIS™ Penumbra System ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1HWISzimAbEiFtrfG1Gt5LcL1BO0L83Xp4y-wXDzINSJJyyskv/?limit=15&utm_campaign=pubmed-2&fc=20250326033856}} There is growing [[interest]] and [[evidence]] in [[spontaneous intracerebral hemorrhage]] (ICH) evacuation with minimally invasive surgery (MIS). If early ICH evacuation becomes the standard of care, training neurointerventionalists to perform MIS would expand global access to treatment. We present a retrospective analysis of patients who underwent MIS-ICH evacuation performed by interventional neurologists in collaboration with neurosurgeons. Method: Patients meeting prespecified criteria underwent MIS-ICH evacuation using the Artemis (Penumbra) by an interventional neurologist-neurosurgeon team. Baseline demographic, clinical, and radiographic characteristics were collected. Procedure location was recorded. The primary outcome of interest was the rate of symptomatic rebleeding. Secondary outcomes included hematoma reduction, serious adverse events, length of stay, disposition, and discharge and 6 month functional status. Results: 19 patients were included in this analysis. One third of cases were performed in the neuroangiography suite using intraprocedural flat panel CT and the rest were performed in the operating room. All were performed under neuronavigation using AxiEM (Medtronic-Stealth-Station). There was a median 80% hematoma reduction from a median preoperative ICH volume of 31.1 mL (IQR 26.2-56.4). A post-procedural hematoma volume of <15 mL was achieved in 67% of cases, comparable with that seen in the [[ENRICH trial]] (Early Minimally Invasive Removal of Intracerebral Hemorrhage) trial (72.7%). No patients developed symptomatic post-procedural hematoma expansion. Conclusion: This study suggests that MIS-ICH evacuation can be performed safely and effectively by trained neurointerventionalists. Our experience also supports the ability to perform MIS-ICH evacuation in the neuroangiography suite. We advocate for the development of a standardized neurointerventional training protocol and certification pathway for the performance of MIS-ICH evacuation with the goal of improving global access to care ((Tekle W, Benites G, Miller S, Betancourt A, Hassan AE. Minimally invasive surgery for evacuation of intracerebral hematoma by neurointerventionalists: initial experience. J Neurointerv Surg. 2025 Jan 6:jnis-2024-022237. doi: 10.1136/jnis-2024-022237. Epub ahead of print. PMID: 39762031.)) ===== MIND study ===== [[MIND study]] 1: Tekle W, Benites G, Miller S, Betancourt A, Hassan AE. Minimally invasive surgery for evacuation of intracerebral hematoma by neurointerventionalists: initial experience. J Neurointerv Surg. 2025 Jan 6:jnis-2024-022237. doi: 10.1136/jnis-2024-022237. Epub ahead of print. PMID: 39762031. 5: Lynch DG, Mehta SH, Shah KA, Toscano D, Pruitt R, Woo HH. Endoscopic Third Ventriculostomy Using Penumbra Artemis™ Neuro Evacuation Device: Technical Case Report and Operative Video. Cureus. 2023 Sep 22;15(9):e45761. doi: 10.7759/cureus.45761. PMID: 37872915; PMCID: PMC10590497. 6: Peron S, Galante N, Creatura D, Sicuri GM, Stefini R. Use of a neuro- evacuation device for the endoscopic removal of third ventricle colloid cysts. Front Surg. 2023 Jul 11;10:1214290. doi: 10.3389/fsurg.2023.1214290. PMID: 37496716; PMCID: PMC10368470. 10: Katsevman GA, Arteaga D, Razzaq B, Marsh RA. Burr-Hole Evacuation of an Acute Epidural Hematoma using the Artemis Neuroevacuation Device With Flexible Endoscopic Visualization: 2-Dimensional Operative Video. World Neurosurg. 2021 Jun;150:18. doi: 10.1016/j.wneu.2021.03.021. Epub 2021 Mar 17. PMID: 33741544. 11: Khattar NK, McCallum AP, Fortuny EM, White AC, Ball TJ, Adams SW, Meyer KS, Wei G, John KD, Bak E, Sieg EP, Ding D, James RF. Minimally Invasive Endoscopy for Acute Subdural Hematomas: A Report of 3 Cases. Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):310-316. doi: 10.1093/ons/opaa390. PMID: 33372226. 12: Zahra K, Turnbull MT, Zubair AC, Siegel JL, Venegas-Borsellino CP, Tawk RG, Freeman WD. A Combined Approach to Intracerebral Hemorrhage: Intravenous Mesenchymal Stem Cell Therapy with Minimally Invasive Hematoma Evacuation. J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104931. doi: 10.1016/j.jstrokecerebrovasdis.2020.104931. Epub 2020 May 30. PMID: 32689636. 13: Kellner CP, Song R, Pan J, Nistal DA, Scaggiante J, Chartrain AG, Rumsey J, Hom D, Dangayach N, Swarup R, Tuhrim S, Ghatan S, Bederson JB, Mocco J. Long- term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurointerv Surg. 2020 May;12(5):489-494. doi: 10.1136/neurintsurg-2019-015528. Epub 2020 Jan 8. PMID: 31915207; PMCID: PMC7231458. 14: Khattar NK, Fortuny EM, Wessell AP, John KD, Bak E, Adams SW, Meyer KS, Schirmer CM, Simard JM, Neimat JS, Ding D, James RF. Minimally Invasive Surgery for Spontaneous Cerebellar Hemorrhage: A Multicenter Study. World Neurosurg. 2019 Sep;129:e35-e39. doi: 10.1016/j.wneu.2019.04.164. Epub 2019 Apr 28. PMID: 31042595.