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Swiss trial of decompressive craniectomy versus best medical treatment of spontaneous supratentorial intracerebral haemorrhage (SWITCH): an international, multicentre, randomised-controlled, two-arm, assessor-blinded trial

Lookup NU author(s): Emeritus Professor David Mendelow

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Abstract

© European Stroke Organisation 2024. Rationale: Decompressive craniectomy (DC) is beneficial in people with malignant middle cerebral artery infarction. Whether DC improves outcome in spontaneous intracerebral haemorrhage (ICH) is unknown. Aim: To determine whether DC without haematoma evacuation plus best medical treatment (BMT) in people with ICH decreases the risk of death or dependence at 6 months compared to BMT alone. Methods and design: SWITCH is an international, multicentre, randomised (1:1), two-arm, open-label, assessor-blinded trial. Key inclusion criteria are age ⩽75 years, stroke due to basal ganglia or thalamic ICH that may extend into cerebral lobes, ventricles or subarachnoid space, Glasgow coma scale of 8–13, NIHSS score of 10–30 and ICH volume of 30–100 mL. Randomisation must be performed <66 h after onset and DC <6 h after randomisation. Both groups will receive BMT. Participants randomised to the treatment group will receive DC of at least 12 cm in diameter according to institutional standards. Sample size: A sample of 300 participants randomised 1:1 to DC plus BMT versus BMT alone provides over 85% power at a two-sided alpha-level of 0.05 to detect a relative risk reduction of 33% using a chi-squared test. Outcomes: The primary outcome is the composite of death or dependence, defined as modified Rankin scale score 5–6 at 6 months. Secondary outcomes include death, functional status, quality of life and complications at 180 days and 12 months. Discussion: SWITCH will inform physicians about the outcomes of DC plus BMT in people with spontaneous deep ICH, compared to BMT alone. Trial registration: ClinicalTrials.gov Identifier: NCT02258919.

Publication metadata

Author(s): Fischer U, Fung C, Beyeler S, Butikofer L, Z'Graggen W, Ringel F, Gralla J, Schaller K, Plesnila N, Strbian D, Arnold M, Hacke W, Juni P, Mendelow AD, Stapf C, Al-Shahi Salman R, Bressan J, Lerch S, Bassetti CLA, Mattle HP, Raabe A, Beck J

Publication type: Article

Publication status: Published

Journal: European Stroke Journal

Year: 2024

Pages: Epub ahead of print

Online publication date: 12/02/2024

Acceptance date: 18/01/2024

ISSN (print): 2396-9873

ISSN (electronic): 2396-9881

Publisher: SAGE Publications Ltd

URL: https://doi.org/10.1177/23969873241231047

DOI: 10.1177/23969873241231047

PubMed id: 38347736

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