Risk profile of decompressive hemicraniectomy for malignant stroke after revascularization treatment

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:420

Article

Alzayiani, Mohamed¹  Schmidt, Tobias¹  Veldeman, Michael¹  Riabikin, Alexander³  Brockmann, Marc A.^3,4  Schiefer, Johannes²  Clusmann, Hans¹  Schubert, Gerrit A.¹  Albanna, Walid¹ 

[1] Rhein Westfal TH Aachen, Dept Neurosurg, Pauwelsstr 30, D-52074 Aachen, Germany

[2] Rhein Westfal TH Aachen, Dept Neurol, Aachen, Germany

[3] Rhein Westfal TH Aachen, Dept Diagnost & Intervent Neuroradiol, Aachen, Germany

[4] Univ Med Ctr Mainz, Dept Neuroradiol, Mainz, Germany

关键词: Decompressive hemicraniectomy;    Stroke;    Malignant middle cerebral artery infarction (MMI);    Thrombolysis;    Thrombectomy;    Risk profile;   

DOI  :  10.1016/j.jns.2020.117275

来源: Elsevier

【 摘 要 】

Objective: Revascularization by pharmacological and/or endovascular treatment is an effective therapy for acute ischemic stroke caused by artery occlusion. In the context of malignant middle cerebral artery infarction (MMI), decompressive hemicraniectomy (DHC) can be life-saving. However, its effectiveness and safety after revascularization have not been thoroughly assessed. This retrospective study aimed to determine the risk profile of presurgical revascularization treatment (RT) for subsequent DHC. Methods: A total of 152 consecutive patients treated by DHC after MMI were identified between 2012 and 2015. After elimination of cases with previous stroke and cases pre-treated with antiplatelets or anticoagulants (increased postoperative bleeding), twenty-four out of fifty patients (n = 24/50, 48%) received pre-surgical revascularization treatment by intravenous thrombolysis (TL), mechanical thrombectomy (MT) or a combination of both. Demographic data was compared alongside perioperative, postoperative complications (intra / extracerebral hemorrhage, revision surgery due to hemorrhage or infection, and overall mortality) and economic parameters. Results: Comparing patients with and without prior RT, there was no statistically significant difference in duration of surgery (RT: 83 [57-116] min vs. no-RT: 96 [69-119] min, p = 0.308), intraoperative blood loss (RT: 300 [225-375] ml vs. no-RT: 300 [250-400] ml, p = 0.763), intraoperative transfusion requirement (RT: 12.5% vs. no-RT: 26.9%, p = 0.294), or need for volume substitution (RT: 1300 [1200-1400] ml vs. no-RT: 1200 [1100-1400] ml, p = 0.359). The rate of postoperative complications was also comparable in both groups, including intra /extracerebral hemorrhage, revision due to hemorrhage or infections, and mortality (p = 0.814, p = 0.520, p = 0.697, and p = 0.769). Health economic parameters were not affected (ventilation time: RT: 309 [12-527] hrs. vs. no-RT: 444 [171-605] hrs., p = 0.120, length of stay: RT: 23 [13 32] days vs. no-RT: 28 [19-41], p = 0.156, and stay costs: RT: 27768 [13044-60,248] (sic) vs. no-RT: 35422 [21225-49,585] (sic), p = 0.312). Conclusion: DHC for patients with MMI who previously received revascularization therapy appears to be safe and not associated with a higher complication rate or increased health economic burden.

【 授权许可】

Free