Decompressive craniectomy for cerebral infarction. An experimental study in rats

Forsting, M.; Reith, Wolfgang; Schabitz, W-R; Heiland, Sabine; von, Kummer R; Hacke, Werner; K, Sartor

doi:10.1097/00008506-199507000-00010

Cited by 62 publications

(88 citation statements)

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“…11,16 Rationally, the clear association between CC status and final infarct volume 9,17 induces to presume the same association with the risk to develop mMCAi seen in experimental animal models. 18 Our study has also detected this significant association of CC status and infarct volume.…”

Section: Discussionsupporting

confidence: 73%

“…The mean age of the series was 65.1±13.8 years, and the median baseline NIHSS was 18 (interquartile range, [13][14][15][16][17][18][19][20] In the univariate analysis, patients with mMCAi had significantly higher infarct volume (230.42 versus 55.58 mL; P<0.001) in the 24-hour CT control.…”

Section: Resultsmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Another limitations are the lack of information on early recanalization in those patients who did not received reperfusion therapies and our time frame for determine recanalization. However, on the analysis of the influence of recanalization on mMCAi evolution, these patients were excluded.…”

Section: Discussionmentioning

confidence: 99%

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Poor Collateral Circulation Assessed by Multiphase Computed Tomographic Angiography Predicts Malignant Middle Cerebral Artery Evolution After Reperfusion Therapies

Flores

Rubiera

Ribó

et al. 2015

Stroke

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O ne of the most devastating complications of ischemic stroke is evolving to malignant middle cerebral artery infarction (mMCAi). The mMCAi evolution occurs in ≤10% of the patients with acute ischemic stroke, especially affecting young people. The mortality rate of mMCAi arises ≤80% in nonsurgery cases, with a high proportion of severe disability in the rest of cases. 1Early detection and management with praecox decompressive surgery within 48 hours may improve the vital and functional outcome of these patients.2,3 Therefore, early indicators of mMCAi evolution during the first hours after ischemic stroke symptoms onset are of high relevance.Several predictors of mMCAi had been evaluated in the acute phase. Neuroimaging parameters as baseline Background and Purpose-Collateral circulation (CC) has been associated with recanalization, infarct volume, and clinical outcome in patients undergoing acute reperfusion therapies. However, its relationship with the development to malignant middle cerebral artery infarction (mMCAi) has not been evaluated. Our aim was to determine the impact of CC using multiphase computed tomographic angiography (during the acute stroke phase in the prediction of mMCAi. Methods-Patients with consecutive acute stroke with <4.5 hours who were evaluated for reperfusion therapies and presented with an M1-MCA or terminal internal carotid artery occlusion by CTA were included. CC was evaluated on 6 grades by multiphase CTA according to the University of Calgary CC Scale; CC status was defined as poor (grades, 0-3) or good (grades, 4-5). The mMCAi was defined according to clinical and radiological criteria. Recanalization was assessed with transcranial Doppler at 24 hours and final Thrombolysis in Brain Ischemia score ≥2b in patients undergoing endovascular reperfusion treatment. Results-Eighty-two patients were included. Mean age was 65.1±13.83 years, median baseline National Institutes of Health Stroke Scale score was 18 (interquartile range, 13-20), and 67.9% M1 and 32.1% terminal internal carotid artery occlusions. Fifty-three patients received endovascular reperfusion treatment. Fifteen patients developed mMCAi. In the univariate analysis, patients with mMCAi had lower CC scores (2.29 versus 3.71; P=0.001). Endovascular reperfusion treatment was associated with lower rate of mMCAi development than only intravenous reperfusion treatment (9.4% versus 29.6%; P=0.028). Patients with poor CC had higher risk of developing mMCAi (13% versus 2%; P=0.001).On the multivariate analysis adjusted by age, vessel occlusion, baseline National Institutes of Health Stroke Scale, and recanalization, the presence of poor CC by multiphase CTA was the only independent predictor of mMCAi (P=0.048; odds ratio, 9.72; 95% confidence interval, 1.387-92.53). Conclusions-CC assessment by multiphase CTA independently predicts malignant MCA infarction progression. In patients with persistent occlusion after reperfusion therapies, the presence of poor CC may improve the early mMCAi detection and management.

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Section: Discussionsupporting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Poor Collateral Circulation Assessed by Multiphase Computed Tomographic Angiography Predicts Malignant Middle Cerebral Artery Evolution After Reperfusion Therapies

Flores

Rubiera

Ribó

et al. 2015

Stroke

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“…Ivamoto et al [29] have expressed that the survival of eighteen patients undergoing craniectomy for cerebral infarction was prolonged by 60%; however, survival was further decreased and substantial disability developed in the patients who did not undergo craniectomy. Forsting et al [30] have demonstrated that DC did not only reduce mortality but also infarction size in cerebral ischemia. Kondziolka and Fazl [31] have carried out a study in five cases and stated that survival was prolonged with DC and long-term functional outcomes were encouraging.…”

Section: Discussionmentioning

confidence: 97%

Effects of Decompressive Craniectomy, Hypertonic Saline Solution and Mannitol in an Experimental Model of Cerebral Ischemia

Çalıkoğlu¹

2015

Ulus Travma Acil Cerrahi Derg

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“…Decompressive craniectomy in trauma unlike in stroke remains controversial. In animal studies with artificially induced intracranial lesions, craniectomy has been linked to increased cerebral edema hemorrhagic infarcts and cortical necrosis (Moody R 1968;Cooper P 1979;Forsting M 1995). However decreased intracranial pressure, improved cerebral perfusion pressure and increased oxygen tension are also reported following craniectomy in trauma (Moody R 1968;Burkert W 1988).…”

Section: Assessment Of the Trauma Patientmentioning

confidence: 99%

Decompressive Craniectomy: Surgical Indications, Clinical Considerations and Rationale

Adewumi¹,

Colohan²

2012

Brain Injury - Pathogenesis, Monitoring, Recovery and Management

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Decompressive craniectomy for cerebral infarction. An experimental study in rats

Cited by 62 publications

References 0 publications

Poor Collateral Circulation Assessed by Multiphase Computed Tomographic Angiography Predicts Malignant Middle Cerebral Artery Evolution After Reperfusion Therapies

Poor Collateral Circulation Assessed by Multiphase Computed Tomographic Angiography Predicts Malignant Middle Cerebral Artery Evolution After Reperfusion Therapies

Effects of Decompressive Craniectomy, Hypertonic Saline Solution and Mannitol in an Experimental Model of Cerebral Ischemia

Decompressive Craniectomy: Surgical Indications, Clinical Considerations and Rationale

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