ISC 2025 | Addressing the unmet needs in ICH: the bundle of care and trans-sulcal approach
Valeria Caso, MD, PhD, FESO, comments on the key unmet needs of patients with intracerebral hemorrhage (ICH), emphasizing the importance of a structured approach to treatment and timely intervention. Prof. Caso speaks about the bundle of care, which is being assessed in the I-CATCHER trial (NCT06429332), and the trans-sulcal approach to managing ICH, which has the potential to improve outcomes for patients. This interview took place at the 2025 International Stroke Conference (ISC), held in Los Angeles, CA.
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Transcript
Intracerebral hemorrhage is now the question, you know, in 2023 there was this ENRICH trial about the translocal surgery, minimally-invasive surgery and also the bundle of care. And what I think is that we have to learn that intracerebral hemorrhage is a brain vessel disease and we have to teach all of our colleagues that in even also in intracerebral hemorrhage, time is brain. So everything has to be done very fast...
Intracerebral hemorrhage is now the question, you know, in 2023 there was this ENRICH trial about the translocal surgery, minimally-invasive surgery and also the bundle of care. And what I think is that we have to learn that intracerebral hemorrhage is a brain vessel disease and we have to teach all of our colleagues that in even also in intracerebral hemorrhage, time is brain. So everything has to be done very fast. Everything has to be done very structured as we’re doing in ischemic stroke. And the bundle of care, which with a little bit more effort in controlling vital functions like glycemia, fever, and especially hypertension, but in a very structured way, we can say save lives. And this was shown in middle and low income countries. And I think with the know-how that we have in high income countries, we will see that this can be replicated. And Teresa Ullberg from Sweden is doing now the I-CATCHER, which is the application of the bundle of care in high income countries. We will be part of this as Italian centers. I will be the PI of this in Italy. Again, to show that if you have a structured approach to intracerebral hemorrhage, you certainly can change the outcome of the patients. And we have to understand if these results of trans-sulcal approach, which is clearly very expensive because the devices are very expensive, if this is replicable in daily life in the real world. I think that because the trans-sulcal approach is not a new approach because they use it for tumors and so on. So now it seems to be like an explosion. And now we have really to understand if this is…because if you look at the trial to get the patient, they started by selecting, I think, more than 10,000 patients. So now we have to see how we can find the right patient in the right moment to be treated. And I personally think that it’s a good approach because you can spare a lot of brain tissue, but still we have to understand how fast, how well, and to replicate it in our normal settings.
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