Can early surgical hematoma evacuation in intracerebral hemorrhage (ICH) be done in such a minimally invasive fashion that it promises significantly more benefit than risk?

That’s what Cleveland Clinic and nine other major U.S. medical centers hope to find out by participating in the Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) study, a phase 3 clinical trial comparing a novel surgical system for clot removal within 24 hours of a hemorrhagic stroke to standard medical management. The system involves specialized devices designed to be manipulated through a small opening in the skull for gentle evacuation of the hematoma with minimal tissue damage.

“Historically, surgery was not a viable option for intracerebral hemorrhage because of damage caused by the surgery itself,” says Mark Bain, MD, a staff neurosurgeon in Cleveland Clinic’s Cerebrovascular Center who’s serving as the site’s principal investigator for the trial. “The system tested in ENRICH offers a minimally disruptive approach to the hematoma, fine control, and a gentle way to remove the hemorrhage. We have high hopes it will prove to be a better treatment for these devastating strokes.”

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