Long-term outcome of decompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A prospective observational study

Vk, Rai; Bhatia, Rohit; Prasad, Kameshwar; Mv, Padma; Singh, Sumit; Rai, Nitish; Suri, Ashish

doi:10.4103/0028-3886.128273

Cited by 23 publications

(6 citation statements)

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“…Other patient characteristics did not differ notably between the two age groups, including sex, race, afflicted stroke side, NIHSS on admission or time from ictus to surgery (24 hr or 48 hr), which is consistent with the findings of other reports[ 16 ]. Nevertheless the NIHSS prior to surgery revealed a significant correlation with poor outcomes, OR 1.53 (p<0.001, CI95% 1.23–1.91) for mRS 5–6 and OR 1.48 (p<0.001, CI95% 1.21–1.82) for death.…”

Section: Discussionsupporting

confidence: 91%

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Decompressive Hemicraniectomy in a South American Population – Morbidity and Outcomes Analysis

et al. 2016

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BackgroundMalignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes.MethodsA retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age.ResultsThe final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30–11.74), whereas only 24% had mRS of 0–4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70–98.48).ConclusionsOlder patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region.

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Section: Discussionsupporting

confidence: 91%

“…Second and no less important, our primary outcome was measured at 90 days during follow-up visits, whereas the main European trials[ 9 – 12 ] assessed the same outcomes at a 1-year follow-up. This longer follow-up may justify different outcomes found on these trials[ 4 , 16 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Decompressive Hemicraniectomy in a South American Population – Morbidity and Outcomes Analysis

et al. 2016

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“…24 In India, Rai et al evaluated 36 stroke patients treated with DC in a cohort of 60 patients and identified a mortality rate of 38% at 1-year and good outcome defined as mRS 4 in 53% of the patients, although the median time from symptoms to surgery was 56 hours. 25 Our results are similar to those found on these retrospective observational studies, but worse than the results found on RCT. In the pooled analysis of individual data from the first three RCT, 75% of the patients in the surgery group had mRS 4 and 22% were dead at 1-year of follow-up.…”

Section: Discussionsupporting

confidence: 86%

Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil

Rodrigues de Oliveira,

Camilo,

Franciscatto

et al. 2023

Arq Neuropsiquiatr

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Background Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors. Objective To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center. Methods A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up. Results We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3–9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16–24). The in-hospital mortality was 30.2%. After a median of 337 [157–393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died. Conclusion Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.

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“…Eventually, 14 studies met our inclusion criteria, comprising of 349 patients in the surgical treatment group and 398 patients in the conservative group. Of which, eight studies (341 patients) were RCTs 13 14 16 17 18 19 20 21 , 4 (286 patients) were retrospective studies and 2 (120 patients) were prospective studies 22 23 24 25 26 27 , The main characteristics of the studies included in this meta-analysis are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery

Huang

Zheng

et al. 2014

Sci Rep

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Early decompressive craniectomy (DC) has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction, whereas efficacy of DC on functional outcome is inconclusive. Here, we performed a meta-analysis to estimate the effects of DC on malignant MCA infarction and investigated whether age of patients and timing of surgery influenced the efficacy. We systematically searched PubMed, Medline, Embase, Cochrane library, Web of Science update to June 2014. Finally, A total of 14 studies involved 747 patients were included, of which 8 were RCTs (341 patients). The results demonstrated that early DC (within 48 h after stroke onset) decreased mortality (OR = 0.14, 95%CI = 0.08, 0.25, p<0.0001) and number of patients with poor functional outcome (modified Rankin scale (mRS)>3) (OR = 0.38, 95%CI = 0.20, 0.73, p = 0.004) for 12 months follow-up. In the subgroup analysis stratified by age, early DC improved outcome both in younger and older patients. However, later DC (after 48h after stroke onset) might not have a benefit effect on lowering mortality or improving outcome in patients with malignant infarction. Together, this study suggested that decompressive surgery undertaken within 48 h reduced mortality and increased the number of patients with a favourable outcome in patients with malignant MCA infarction.

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Long-term outcome of decompressive hemicraniectomy in patients with malignant middle cerebral artery infarction: A prospective observational study

Abstract: DH in malignant MCA infarction not only reduces mortality but also increases chances of a better functional outcome. The benefit of surgery in motor and aphasia recovery is progressive and sustained until 1 year.

Cited by 23 publications

References 14 publications

Decompressive Hemicraniectomy in a South American Population – Morbidity and Outcomes Analysis

Decompressive Hemicraniectomy in a South American Population – Morbidity and Outcomes Analysis

Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil

Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery

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