Minimally Invasive Surgery vs Medical Management Alone for Intracerebral Hemorrhage: The MIND Randomized Clinical Trial
MIND found no significant benefit of minimally invasive hematoma evacuation over medical management alone for disability and death at 180 days or for 30-day mortality.
Editorially appraised and medically reviewed
Study profile
The clinical question
Does minimally invasive hematoma evacuation with the Artemis system within 72 hours improve outcomes after spontaneous supratentorial intracerebral hemorrhage compared with guideline-based medical management alone?
PICO framework
Decision-relevant results
Primary outcome
180 days
OR 1.03
96% CI 0.62–1.72 · P = .45
No statistically significant benefit with surgery
Primary outcome
30 days
7.2% surgery vs 9.8% medical
Difference −2.5 percentage points · 95% CI −11.7 to 4.8
No statistically significant difference
180 days
13.2% surgery vs 18.3% medical
Difference −5.1 percentage points · 95% CI −16.1 to 4.5
No statistically significant difference
Original material
Additional editorial context, figures, and the study authors’ conclusion documented in the article.
The MIND study was published in 2025[^1] and investigated minimally invasive surgery versus conservative management for intracerebral hemorrhage.
In the MIND randomized clinical trial, minimally invasive surgery within 72 hours did not significantly reduce 30-day mortality or improve 180-day disability in patients with supratentorial ICH compared to medical management alone[^1].
Editorial appraisal
Significance
The findings do not support routine use of the studied Artemis procedure to improve long-term functional outcome. Positive secondary and exploratory signals should be treated as hypothesis-generating.
Context
The open-label trial stopped early after 236 participants. The 180-day mRS was imputed for 52 participants, and secondary and exploratory analyses were not adjusted for multiple comparisons.
