Risk profile of decompressive hemicraniectomy for malignant stroke after revascularization treatment
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...
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Published in | Journal of the neurological sciences Vol. 420; p. 117275 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
15.01.2021
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Abstract | 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 pre-surgical revascularization treatment (RT) for subsequent DHC.
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.
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] € vs. no-RT: 35422 [21225–49,585] €, p = 0.312).
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.
•Revascularization treatment (RT) is an effective therapy for acute ischemic stroke.•For malignant middle cerebral artery infarction, decompressive hemicraniectomy (DHC) can be life-saving.•We determined the risk profile of pre-surgical revascularization treatment for subsequent DHC.•DHC after RT appears to be safe and is not associated with a higher complication rate. |
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AbstractList | 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 pre-surgical revascularization treatment (RT) for subsequent DHC.
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.
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] € vs. no-RT: 35422 [21225-49,585] €, p = 0.312).
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. 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 pre-surgical revascularization treatment (RT) for subsequent DHC. 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. 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] € vs. no-RT: 35422 [21225–49,585] €, p = 0.312). 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. •Revascularization treatment (RT) is an effective therapy for acute ischemic stroke.•For malignant middle cerebral artery infarction, decompressive hemicraniectomy (DHC) can be life-saving.•We determined the risk profile of pre-surgical revascularization treatment for subsequent DHC.•DHC after RT appears to be safe and is not associated with a higher complication rate. OBJECTIVERevascularization 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 pre-surgical revascularization treatment (RT) for subsequent DHC. METHODSA 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. RESULTSComparing 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] € vs. no-RT: 35422 [21225-49,585] €, p = 0.312). CONCLUSIONDHC 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. |
ArticleNumber | 117275 |
Author | Riabikin, Alexander Veldeman, Michael Brockmann, Marc A. Schiefer, Johannes Clusmann, Hans Alzayiani, Mohamed Schubert, Gerrit A. Schmidt, Tobias Albanna, Walid |
Author_xml | – sequence: 1 givenname: Mohamed surname: Alzayiani fullname: Alzayiani, Mohamed organization: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany – sequence: 2 givenname: Tobias surname: Schmidt fullname: Schmidt, Tobias organization: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany – sequence: 3 givenname: Michael surname: Veldeman fullname: Veldeman, Michael organization: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany – sequence: 4 givenname: Alexander surname: Riabikin fullname: Riabikin, Alexander organization: Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany – sequence: 5 givenname: Marc A. surname: Brockmann fullname: Brockmann, Marc A. organization: Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany – sequence: 6 givenname: Johannes surname: Schiefer fullname: Schiefer, Johannes organization: Department of Neurology, RWTH Aachen University, Aachen, Germany – sequence: 7 givenname: Hans surname: Clusmann fullname: Clusmann, Hans organization: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany – sequence: 8 givenname: Gerrit A. surname: Schubert fullname: Schubert, Gerrit A. organization: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany – sequence: 9 givenname: Walid surname: Albanna fullname: Albanna, Walid email: WalidAlbanna@Yahoo.de organization: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany |
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CitedBy_id | crossref_primary_10_25005_2074_0581_2023_25_3_431_440 crossref_primary_10_1007_s12028_023_01820_3 crossref_primary_10_1007_s00101_021_00977_w crossref_primary_10_1177_23969873221143210 crossref_primary_10_3390_jcm13030918 |
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Keywords | Risk profile Decompressive hemicraniectomy Stroke Thrombectomy Thrombolysis Malignant middle cerebral artery infarction (MMI) |
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Snippet | Revascularization by pharmacological and/or endovascular treatment is an effective therapy for acute ischemic stroke caused by artery occlusion. In the context... OBJECTIVERevascularization by pharmacological and/or endovascular treatment is an effective therapy for acute ischemic stroke caused by artery occlusion. In... |
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SubjectTerms | Brain Ischemia Decompressive Craniectomy - adverse effects Decompressive hemicraniectomy Humans Infarction, Middle Cerebral Artery - surgery Malignant middle cerebral artery infarction (MMI) Retrospective Studies Risk profile Stroke Stroke - surgery Thrombectomy Thrombolysis Treatment Outcome |
Title | Risk profile of decompressive hemicraniectomy for malignant stroke after revascularization treatment |
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