ABSTRACT NUMBER: ESOC2026OT151 THE DUTCH INTRACEREBRAL HAEMORRHAGE SURGERY TRIAL (DIST); MINIMALLY INVASIVE ENDOSCOPY-GUIDED SURGERY IN SPONTANEOUS, SUPRATENTORIAL INTRACEREBRAL HAEMORRHAGE

Abstract Background and aims Increasing evidence suggests that surgical treatment of intracerebral haemorrhage (ICH) may be beneficial, in particular with minimally invasive procedures and when performed early. ICH accounts for 16-19% of all strokes in Western Europe and it contributes profoundly to mortality and disability. Methods The aim of the Dutch ICH Surgery Trial (DIST) is to assess whether minimally invasive endoscopy-guided surgery within 8 hours of symptom onset in addition to standard medical management improves functional outcome after spontaneous supratentorial ICH when compared to standard medical management alone. Results DIST is a multicentre, prospective, randomised, open clinical trial with blinded outcome assessment. We will include 600 adults (≥18 years) with a spontaneous supratentorial ICH with a haematoma volume ≥10 mL and NIHSS ≥2. Patients with an underlying aneurysm, arteriovenous malformation or fistula, cerebral venous sinus thrombosis, cavernoma or tumour will be excluded. Patients will be randomised (1:1) to minimally invasive endoscopy-guided surgery within 8 hours of symptom onset in addition to standard medical management or to standard medical management alone. Conclusions The primary outcome is the modified Rankin Scale score at 180 days. The treatment effect estimate will be adjusted for known prognostic variables. Secondary outcomes include safety, technical efficacy, and cost-effectiveness. Conflict of interest