Decompressive craniectomy after intra-arterial thrombolysis: safety and outcome. Issue 8 (20th June 2010)

• Record Type: Journal Article
• Authors: Fischer, Urs; Taussky, Philipp; Gralla, Jan; Arnold, Marcel; Brekenfeld, Caspar; Reinert, Michael; Meier, Niklaus; Mono, Marie-Luise; Schroth, Gerhard; Mattle, Heinrich P; Nedeltchev, Krassen
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 82:Issue 8(2011)
• Page Start: 885
• Page End: 887
• Publication Date: 2010-06-20
• Subjects: Intra-arterial thrombolysis -- decompressive craniectomy -- outcome -- cerebrovascular -- interventional -- neurosurgery -- stroke; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.2009.198648
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objectives: Data on decompressive craniectomy (DC) after intra-arterial thrombolysis (IAT) for treatment of malignant middle cerebral artery (MCA) stroke are lacking. Methods: The authors compared consecutive patients with middle cerebral artery (MCA) strokes who underwent decompressive craniectomy (DC) after IAT with DC patients without prior thrombolysis. Results: Thirty of 2395 consecutive patients with acute ischaemic stroke or transient ischaemic attack were treated with DC because of space-occupying oedema 12–72 h after symptom onset. Fifteen patients underwent intra-arterial thrombolysis (IAT) prior to DC. Baseline characteristics did not differ between thrombolysed and non-thrombolysed patients except for lower National Institute of Health Stroke Scale score in non-thrombolysed patients (median National Institute of Health Stroke Scale 17 vs 14, p=0.033). The outcome at 3 months was favourable (modified Rankin scale 0–3) in seven (47%) thrombolysed patients and in four (27%) non-thrombolysed patients (p=0.45). Mortality and major complications after DC did not differ between the two groups (p>0.05). Older age (p=0.037) and previous hypertension (p=0.047) independently predicted unfavourable outcome in DC patients, but not IAT prior DC. Conclusions: There was no difference of outcome of patients with DC with or without prior IAT. DC after IAT did not cause any more complications than DC without prior thrombolysis.