E-050 Proper indication for decomprssive craniectomy for the patient with massive brain edema after intraarterial thrombectomy. (23rd July 2022)

• Record Type: Journal Article
• Authors: Won, Y; Yoo, D
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A102
• Page End: A102
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.161
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Objective: There have been many reports showing that early decompressive craniectomy (DC) within a limited time window for a large hemispheric infarction has been effective in saving one's life and improving a neurologic outcome. However, most of these reports had studied before the intraarterial thrombectomy (IA-Tx) has become a popular treatment. The objective of this study was to find the proper indications for DC after IA-Tx and the effect of successful recanalization after IA-Tx on neurologic outcomes. Methods: A total of 67 patients with anterior circulation infraction who underwent DC after treating with IA-Tx who were included in this study. Glasgow coma scale (GCS), initial intracranial pressure, midline shifts and surgical time window were measured for all patients just before DC. Successful recanalization was evaluated after IA-Tx. These factors were analyzed for neurologic outcomes (favorable outcome: 0~2 mRS) at 90 days after the treatment. Results: For the patients treated with IA-Tx and DC, the GCS ≥ 8 had the lowest neurologic status ( p = 0.013). The successful recanalization after IA-Tx had a significant influence on favorable outcomes ( p = 0.001) and mortality ( p = 0.000). However, surgical time window ( p = 0.803) and midline shift ( p = 0.247) were not correlated with favorable outcomes. Conclusions: On this study, results suggest that the surgical indication for DC after IA-Tx should focus on patient neurologic status (GCS ≥ 8) rather than surgical time window, similar to the treatment guideline for DC in traumatic brain injury. Disclosures: Y. Won: None. D. Yoo: None.