Minimally invasive evacuation for spontaneous supratentorial haemorrhage: scoping for candidates and hypothetical logistic burdens in a pragmatic scenario.

Minimally invasive surgery (MIS) is being evaluated as a promising treatment for spontaneous intracerebral haemorrhage (ICH). Transitioning to early clot removal requires accurate estimation of eligible candidates in practical scenarios. We conducted a prospective population-based observational study of ICH across all public stroke centres in Catalonia-Spain, between 2020 and 2022. Patient characteristics, need for conventional surgery and clinical outcomes were recorded. Inclusion and exclusion criteria from major trials assessing MIS for ICH were retrospectively applied to obtain the number of potential candidates. Sensitivity analyses examined the impact of withdrawal of care (WoC) decisions and variations in selection criteria on eligibility estimates. Among 2,197 reported ICH cases, 1,571 met the selection criteria and had complete follow-up to be analysed. Annually, 113 (14.4%) patients met the criteria for catheter plus thrombolysis evacuation (MISTIE-III criteria), and 45 (5.7%) for parafascicular evacuation (ENRICH criteria). Eligibility rates varied considerably depending on age and haematoma volume thresholds, and with changes in WoC, which affected 20-29% of potential candidates. Conventional evacuation was performed as a life-saving measure in 40 (5%) patients annually according to local protocols. If implemented, MIS protocols could increase the number of clot evacuation procedures in a range of 1.1-1.8 times. In a hypothetical scenario of MIS implementation for early ICH evacuation protocol in Catalonia, 5.7-14.4% of patients could potentially qualify for surgery. Consequently, the annual number of emergent clot evacuation procedures might increase 1.1-fold to 1.8-fold, highlighting substantial impact on healthcare infrastructure and resource planning.