Early Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction in Asian patients: A single centre study.

Early Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction in Asian patients: A single centre study.

World Neurosurg. 2018 Jan 06;:

Authors: Paliwal P, Kazmi F, Teoh HL, Yeo LL, Seet RC, Yeo TT, Sein L, Chou N, Tch T, Chan BP, Sharma VK

Abstract
INTRODUCTION: Early Decompression craniectomy(within 48-hours of stroke-onset) in acute and malignant middle cerebral artery(MCA) ischemic stroke(IS) reduces mortality and increases the proportion of patients with favourable functional outcome. Various cultural and social issues anong Asians lead to some differences in clinical practice specially when surgical interventions are involved. Accordingly decompressive craniectomy in Asian stroke patients is often delayed.
MATERIALS & METHODS: Data for all acute IS patients hospitalized to our center were entered into a prospectively maintained registry. In this retrospective analysis, data for all malignant MCA IS patients who underwent decompressive craniectomy were extracted. Various demographic, clinical and neuroimaging factors were analyzed for identifying independent predictors of favorable functional outcome at 6-months, which was defined as modified Rankin Scale score of 0-3 points.
RESULTS: From January 2005 to December 2014, a total of 75 patients with acute MCA IS underwent decompressive craniectomy. Median age was 55 years[Inter Quartile Range (IQR) 44-64] with male preponderance (66%) and median National Institute of Health Stroke Scale(NIHSS) score 21-points(IQR 18-24). Considerable proportion of them (38.7%) received intravenous thrombolysis. Majority(70%) of patients suffered right MCA IS and decompressive surgery was performed within 48-hours of symptom-onset in 50(67%) of the patients. Favorable functional outcome was achieved in 25(33.3%) patients at 6-months. Right MCA stroke (OR= 9.158;95% CI 1.881-44.596,p=0.006) and early decompression surgery (OR = 4.011;95% CI 1.058-15.208,p=0.041) were independent predictors of favorable functional outcome at 6-months.
CONCLUSION: Early decompression craniectomy, especially in right MCA ischemic stroke is associated with better favorable functional outcome.

PMID: 29317364 [PubMed - as supplied by publisher]

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