Outcomes After Decompressive Craniectomy for Ischemic Stroke: A Volumetric Analysis

Parish, Jonathan; Asher, Anthony M.; Pfortmiller, Deborah; Clemente, Jonathan D.; Stetler, William R.; Bernard, J

doi:10.1016/j.wneu.2020.10.036

Cited by 3 publications

(1 citation statement)

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“…A positive association has been reported in 3 retrospective and monocentric studies analyzing infarct volumes before surgery, after surgery, or at both times with either CT or MRI and complete outcome assessment at 3, 6, or 12 months. 8,9,25 Infarct volume thresholds for the prediction of favorable outcome were substantially higher compared to our present study: one study using CT in 34 patients before surgery reported a threshold of 300 mL with 100% sensitivity and 65% specificity after 6 months 9 ; the second study in 52 patients using MRI before surgery reported 280 mL with 100% sensitivity and 29% specificity after 3 months 25 ; and the largest of these studies using CT in 96 patients after surgery reported 270 mL with 81% sensitivity and 74% specificity after 12 months. 8 What is most remarkable is that, despite these differences, clinical baseline data and rate of favorable outcome are quite similar among all studies, including the present analysis.…”

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confidence: 99%

Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction

et al. 2021

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ObjectiveTo determine the impact of infarct volume before hemicraniectomy in malignant middle cerebral artery infarction (MMI) as an independent predictor for patient selection and outcome prediction, we retrospectively analyzed data of 140 patients from a prospective multi-center study.MethodsPatients from the DESTINY-Registry that underwent hemicraniectomy after ischemic infarction of >50% of the middle cerebral artery territory were included. Functional outcome according to the modified Rankin Scale (mRS) was assessed at 12 months. Unfavorable outcome was defined as mRS 4-6. Infarct size was quantified semi-automatically from computed tomography or magnetic resonance imaging before hemicraniectomy. Subgroup analyses in patients fulfilling inclusion criteria of randomized trials in younger patients (age≤60y) were predefined.ResultsAmong 140 patients with complete datasets (34% female, mean (SD) age 54 (11) years), 105 (75%) had an unfavorable outcome (mRS > 3). Mean (SD) infarct volume was 238 (63) ml. Multivariable logistic regression identified age (OR 1.08 per 1 year increase; 95%-CI 1.02-1.13; p=0.004), infarct size (OR 1.27 per 10ml increase; 95%-CI 1.12-1.44; p<0.001) and NIHSS (OR 1.10; 95%-CI 1.01-1.20; p=0.030) before hemicraniectomy as independent predictors for unfavorable outcome. Findings were reproduced in patients fulfilling inclusion criteria of randomized trials in younger patients. Infarct volume thresholds for prediction of unfavorable outcome with high specificity (94% in overall cohort and 92% in younger patients) were more than 258 ml before hemicraniectomy.ConclusionOutcome in MMI strongly depends on age and infarct size before hemicraniectomy. Standardized volumetry may be helpful in the process of decision making concerning hemicraniectomy.

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