Decompressive craniectomy after intravenous tissue plasminogen activator administration for stroke

Takeuchi, Satoru; Wada, Koichiro; Nawashiro, Hiroshi; Arimoto, Hirohiko; Ohkawa, Hidenori; Masaoka, Hiroyuki; Otani, Naoki; Takasato, Yoshio

doi:10.1016/j.clineuro.2012.03.044

Cited by 23 publications

(17 citation statements)

References 12 publications

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“…Several other studies have failed to find a significant effect of tPA administration on poor outcome and mortality after surgery as well. 2,6,28 In the present study 29% of patients received intravenous tPA prior to DH. Although the theoretical risk of increased bleeding during and after the procedure exists, cases involving tPA intervention or endovascular therapy should not exclude the need for DH.…”

Section: Discussionmentioning

confidence: 99%

Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke

Daou

Kent

Montaño

et al. 2016

JNS

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P atients presenting with large ischemic strokes may develop uncontrollable, progressive brain edema that puts them at risk for compression of brain parenchyma and cerebral herniation. 23 There are a limited number of therapeutic options, but research has shown that operative procedures, such as decompressive hemicraniectomy (DH), decrease patient mortality.32 Malignant infarction treated only by conservative approaches results in a mortality rate of 80% within the 1st week of the stroke. 15Edema that does not respond to medical treatment necessitates DH as a life-saving procedure. Studies have demonstrated that DH surgery can result in a reduction of mortality rate to 30% and, if decompression is performed within 24 hours of stroke onset, to 10%. 7,12,18,24,32 While DH imabbreviatioNs BMI = body mass index; DH = decompressive hemicraniectomy; DVT = deep vein thrombosis; ICA = internal carotid artery; IVC = inferior vena cava; MCA = middle cerebral artery; MI = myocardial infarction; MLS = midline shift; mRS = modified Rankin Scale; NIHSS = National Institutes of Health Stroke Scale; tPA = tissue plasminogen activator. obJective Patients presenting with large-territory ischemic strokes may develop intractable cerebral edema that puts them at risk of death unless intervention is performed. The purpose of this study was to identify predictors of outcome for decompressive hemicraniectomy (DH) in ischemic stroke. methods The authors conducted a retrospective electronic medical record review of 1624 patients from 2006 to 2014. Subjects were screened for DH secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery, or both. Ninety-five individuals were identified. Univariate and multivariate analyses were performed for an array of clinical variables in relationship to functional outcome according to the modified Rankin Scale (mRS). Clinical outcome was assessed at 90 days and at the latest follow-up (mean duration 16.5 months). results The mean mRS score at 90 days and at the latest follow-up post-DH was 4. Good functional outcome was observed in 40% of patients at 90 days and in 48% of patient at the latest follow-up. The mortality rate at 90 days was 18% and at the last follow-up 20%. Univariate analysis identified a greater likelihood of poor functional outcome (mRS scores of 4-6) in patients with a history of stroke .66]; p = 0.017), peak midline shift (MLS) > 10 mm ]; p = 0.011), or a history of myocardial infarction ]; p = 0.04). Multivariate analysis demonstrated elevated odds of poor functional outcome associated with a history of stroke .05]; p = 0.008), MLS > 10 mm ; p = 0.007), a history of diabetes .88]; p = 0.01), delayed time from onset of stroke to DH (OR 1.32 [95% CI 1.02-1.72]; p = 0.037), and evidence of pupillary dilation prior to DH .51]; p = 0.04). Patients with infarction involving the dominant hemisphere had higher odds of unfavorable functional outcome at 90 days ]; p = 0.014), but at the latest follow-up, cerebral dominance was not significantly related to outc...

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Section: Discussionmentioning

confidence: 99%

Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke

Daou

Kent

Montaño

et al. 2016

JNS

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“…Fibrinolytics promote the transformation of plasminogen into plasmin, thereby accelerating the degradation of the fibrin clot. The plasminogen recombinant tissue activator (r-TPA), used in our country, has a half-life of 5 min, however, it is considered that the fibrinolytic effect persists for more than 24 hours Three publications have been published in recent years that demonstrate that the performance of intravenous or intra-arterial fibrinolytics does not increase the risk of hemorrhagic complications in patients undergoing decompressive craniectomies, even when this is done in the first 24 hours after the administration of these drugs [19][20][21].…”

Section: Journal Of Universal Surgery Issn 2254-6758mentioning

confidence: 99%

Surgical Treatment of Malignant Cerebral Infarction

Bertullo¹

2017

J Univer Surg

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Cerebrovascular disease (CVD) is the second cause of death in the world and the first in Uruguay. The malignant cerebrovascular accident (CVA) represents 5% of the cases of cerebral ischemia in our country. In these patients, the use of preoperative intracranial pressure monitoring has not shown utility. Currently, decompressive craniectomy has managed to reduce the mortality and morbidity of patients with malignant stroke. The clinical case of a patient who presented a malignant CVA is described below and a non-systematic review of the literature on the surgical treatment of them is performed.

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“…Surgery can be safely performed even after intravenous tissue plasminogen activator administration for thrombolysis [38, 39]. The side of the stroke does not seem to affect the vital status after surgical decompression, so it should not influence the choice to operate [32, 40].…”

Section: Best Conditions For Surgerymentioning

confidence: 99%