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Lancet. 2005 Jan 29-Feb 4;365(9457):387-97.

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial.

Collaborators (161)

Mendelow AD, Gregson BA, Stobbart L, Pearson AJ, Wilson J, Fernandes HM, Barer D, Gholkar A, Barnes J, Wooldridge T, Siddique MS, Prasad KS, Deverill M, Shaw MD, Mendelow AD, Karimi A, Barer D, Teasdale GM, Hope DT, Murray GD, Fernandes HM, Gregson BA, Morgan D, Cotterill L, Jones-Jenkins H, Stobbart L, Pearson AJ, Taylor G, Wilson J, Harrison M, Skene A, Ross-Russell R, Strong A, Iannotti F, Illingworth R, Reilly P, Chang DJ, Borah NC, Stranjalis G, Korfias S, Troccoli G, Kolluri S, Cabiol J, Zhao Y, Byrnes D, Unterberg A, Kroppenstedt S, Lewko J, Szydlik P, Garibi J, Pomposo I, Wasserberg J, Kattner K, Limoni P, Pozzati E, Smrcka M, Svoboda T, Vanhorren G, Cristescu A, Pickard JD, Kirkpatrick PJ, Welsh DG, Bereczki D, Szabo S, Kleindienst A, Schakert G, Koy J, Eljamel S, Woebker G, Whittle IR, Falbusch R, Valldares J, Pospiech J, Siefert V, Wasilewski W, Severi P, Deinsberger W, Lindsay KW, Katati MJ, Morera-Molina J, Pellettleri L, Tritthart H, Unger F, Gaab MR, Norris J, Goodden J, Yannopoulos A, Cortbus F, Schwerdtfeger K, Poon WS, Valadka AB, Crimmins D, Bahar S, Krespi Y, Hunt Bobo R, Gvazdaitas AR, Vilcinis R, Klug N, Wedekind C, Klein T, Abdullah JM, Ghani Zamzuri AR, Van Hille P, Goffin J, Hillman J, Mendoza N, O'Neill KS, Bell BA, Kitchen N, Dorward N, Nowak G, Trojanowski T, Saveland H, Blaauw G, Firsching R, Odoriz B, Marks SM, Genarelli T, Gaini SM, Eliava S, Piradov M, von Wild KR, Sephernia A, Schul C, Wassmann H, Jaksche H, Mendelow AD, Fernandes HM, Mitchell P, Mehta VS, Tripathi M, Hope DT, Krivoshapkin A, Loftus CM, Kerr RS, Hankey GJ, Vacek P, Keeley R, Mohapl M, Dbaly V, Davis C, Valeinis E, Aksisks I, Hildebrant G, Vazquez-Barquero A, Kemeny A, Murali R, Thomas J, Lozance K, Singh J, Bhattacharya RN, Harada S, Persson L, Sames M, Smolanka V, Martin C, Cristofori L, Sustickas G, Marchel A, Schonmayer R, Meixensberger J.

Author information

Department of Neurosurgery, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK.



Spontaneous supratentorial intracerebral haemorrhage accounts for 20% of all stroke-related sudden neurological deficits, has the highest morbidity and mortality of all stroke, and the role of surgery remains controversial. We undertook a prospective randomised trial to compare early surgery with initial conservative treatment for patients with intracerebral haemorrhage.


A parallel-group trial design was used. Early surgery combined haematoma evacuation (within 24 h of randomisation) with medical treatment. Initial conservative treatment used medical treatment, although later evacuation was allowed if necessary. We used the eight-point Glasgow outcome scale obtained by postal questionnaires sent directly to patients at 6 months follow-up as the primary outcome measure. We divided the patients into good and poor prognosis groups on the basis of their clinical status at randomisation. For the good prognosis group, a favourable outcome was defined as good recovery or moderate disability on the Glasgow outcome scale. For the poor prognosis group, a favourable outcome also included the upper level of severe disability. Analysis was by intention to treat.


1033 patients from 83 centres in 27 countries were randomised to early surgery (503) or initial conservative treatment (530). At 6 months, 51 patients were lost to follow-up, and 17 were alive with unknown status. Of 468 patients randomised to early surgery, 122 (26%) had a favourable outcome compared with 118 (24%) of 496 randomised to initial conservative treatment (odds ratio 0.89 [95% CI 0.66-1.19], p=0.414); absolute benefit 2.3% (-3.2 to 7.7), relative benefit 10% (-13 to 33).


Patients with spontaneous supratentorial intracerebral haemorrhage in neurosurgical units show no overall benefit from early surgery when compared with initial conservative treatment.

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