Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate
Objective and Methods. The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following D...
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| Format: | Article |
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Wiley
2017-01-01
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| Series: | Stroke Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2017/2507834 |
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| author | Saadat Kamran Naveed Akhtar Abdul Salam Ayman Alboudi Kainat Kamran Arsalan Ahmed Rabia A. Khan Mohsin K. Mirza Jihad Inshasi Ashfaq Shuaib |
| author_facet | Saadat Kamran Naveed Akhtar Abdul Salam Ayman Alboudi Kainat Kamran Arsalan Ahmed Rabia A. Khan Mohsin K. Mirza Jihad Inshasi Ashfaq Shuaib |
| author_sort | Saadat Kamran |
| collection | DOAJ |
| description | Objective and Methods. The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months. Results. In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [P=0.140] and mortality [P=0.975]. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [P<0.001] in patients with early surgery [under 48 hours]. Conclusions. The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery. |
| format | Article |
| id | doaj-art-73487a44186e4943bace83e087466b3d |
| institution | Kabale University |
| issn | 2090-8105 2042-0056 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke Research and Treatment |
| spelling | doaj-art-73487a44186e4943bace83e087466b3d2025-02-03T06:05:47ZengWileyStroke Research and Treatment2090-81052042-00562017-01-01201710.1155/2017/25078342507834Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth RateSaadat Kamran0Naveed Akhtar1Abdul Salam2Ayman Alboudi3Kainat Kamran4Arsalan Ahmed5Rabia A. Khan6Mohsin K. Mirza7Jihad Inshasi8Ashfaq Shuaib9Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, QatarNeuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, QatarNeuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, QatarRashid Hospital, Dubai, UAECollege of Liberal Arts and Sciences, University of Illinois at Chicago, Chicago, IL, USAShifa International Hospital, Islamabad, PakistanNeuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, QatarNeuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, QatarRashid Hospital, Dubai, UAENeuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, QatarObjective and Methods. The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months. Results. In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [P=0.140] and mortality [P=0.975]. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [P<0.001] in patients with early surgery [under 48 hours]. Conclusions. The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery.http://dx.doi.org/10.1155/2017/2507834 |
| spellingShingle | Saadat Kamran Naveed Akhtar Abdul Salam Ayman Alboudi Kainat Kamran Arsalan Ahmed Rabia A. Khan Mohsin K. Mirza Jihad Inshasi Ashfaq Shuaib Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate Stroke Research and Treatment |
| title | Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate |
| title_full | Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate |
| title_fullStr | Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate |
| title_full_unstemmed | Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate |
| title_short | Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate |
| title_sort | revisiting hemicraniectomy late decompressive hemicraniectomy for malignant middle cerebral artery stroke and the role of infarct growth rate |
| url | http://dx.doi.org/10.1155/2017/2507834 |
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