Cut Off Value of Good Pronostic Factor Outcomes in Large Territory Ischemic Stroke Undergoing Early Decompressive Craniectomy

Abstract

Background: Decompressive craniectomy (DC) significantly reduces mortality in large territory ischemic strokes that develop intractable cerebral edema. However, evidence for functional benefit remains sparse and contradictory.
 Objective: This study aimed to assess cut-off value for predictor outcomes of early DC.
 Methods: We conducted a prospective, observational cohort study from December 2016 to June 2021. Patients were screened for ischemic stroke involving the middle cerebral, internal carotid artery or both using the National Institutes of Health Stroke Scale score. All patients underwent DC. Multivariate analysis was performed for an array of clinical variables in relation to functional outcomes according to the modified Rankin Scale (mRS) and Pearson’s correlation coefficient analysis. Clinical outcome was assessed after 3- and 6-month follow-up.
 Results: In total, 243 patients were included in this study. Age ≤71 years (AUC=0.955, p <0.001 accuracy 89.7%), onset to DC ≤9 hours (AUC=0.824, p <0.001 accuracy 78.8%), volume of infarction ≤155 cm3 (AUC=0.939, p <0.001 accuracy 93.6%) and the Alberta Stroke Program Early CT Score or ASPECT score ≥6 (AUC = 1, p <0.001 accuracy 100%) were significantly associated with good clinical outcomes in early DC (mRS 0 to 3).
 Conclusion: Among patients with large territory ischemic strokes undergoing early DC, age ≤71 years, onset to DC ≤9 hours, volume of infarction ≤155 cm3 and ASPECT score ≥6 was significantly associated with good clinical outcomes. All prognostic factors in early DC correlated well with functional outcomes at 6 months which could be used to predict outcome, and consider clinical indications and informed postoperative complications among patients with large territory ischemic stroke.