ENRICH trial: early surgical intervention in intracerebral hemorrhage

Alex Hall, DHSc, MS, RN; Jonathan Ratcliff, MD, MPH; and Gustavo Pradilla, MD; of Emory University School of Medicine in Atlanta, GA, presented the groundbreaking findings of the ENRICH trial (NCT02880878) at the recent ESOC 2023 conference, investigating the effectiveness of early minimally invasive surgical intervention in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). The study started in 2016 and a total of 300 patients were enrolled. The trial employed a randomized adaptive design, comparing minimally invasive trans-sulcal parafascicular surgery to standard medical management within 24 hours of symptom onset. Utility-Weighted modified Rankin Scale [uW-mRS]) at 6 months was assessed as the primary outcome, demonstrating a statistically significant improvement seen in the surgery arm, compared to those receiving medical management alone. The superiority of surgery was seen to be driven by the strong positive effect in lobar ICH. ENRICH is the first randomized, controlled trial to demonstrate a benefit of surgery for ICH. Dr Hall expressed excitement about the potential impact of these findings on the broader medical community. As the data is further analyzed and published, it will serve as a framework for future studies and guide clinicians in making informed decisions regarding treatment strategies.
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