TY - JOUR
T1 - Decompressive craniectomy in symptomatic intracerebral hemorrhage after ischemic stroke
T2 - a multicenter retrospective cohort study
AU - Pressman, Elliot
AU - Gersey, Zachary C.
AU - Jonzzon, Soren B.
AU - Weinberg, Joshua H.
AU - Fogg, David N.
AU - Flaherty, Emily G.
AU - Gross, Bradley A.
AU - Chitale, Rohan V.
AU - Fusco, Matthew R.
AU - Froehler, Michael T.
AU - Vignolles-Jeong, Joshua
AU - Nimjee, Shahid M.
AU - Hanel, Ricardo A.
AU - Cortez, Gustavo M.
AU - Ravi, Saisree
AU - Desai, Sohum K.
AU - Hassan, Ameer E.
AU - Monteiro, Andre
AU - Siddiqui, Adnan H.
AU - Matsoukas, Stavros
AU - Majidi, Shahram
AU - Smith, Teagen
AU - Vakharia, Kunal
AU - Mokin, Maxim
N1 - Publisher Copyright:
©AANS 2025, except where prohibited by US copyright law.
PY - 2025/1
Y1 - 2025/1
N2 - OBJECTIVE Symptomatic intracerebral hemorrhage (sICH) after stroke is a devastating neurological complication. Current guidelines support a “possible benefit” of decompressive craniectomy (DC) for large supratentorial sICH with significant mass effect. METHODS The authors conducted a retrospective study of 8 comprehensive stroke centers. They included all patients who sustained an sICH after acute ischemic stroke (AIS), as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST), from January 2016 to December 2020. They compared patients who underwent DC to those who were treated with standard medical treatment to measure functional outcome at 90 days, primarily as defined by the modified Rankin Scale (mRS) and secondarily by the Glasgow Outcome Scale–Extended (GOS-E). RESULTS Eighty-five patients were identified, 26 of whom (30.5%) underwent DC. Patients who underwent DC were younger (58 years [DC] vs 76 years [no DC], p < 0.001). No patient with a previous history of cancer underwent DC (n = 14, p = 0.004). Twenty-five patients (96.2%) in the DC group underwent thrombectomy versus 54 (91.5%) in the non-DC group (p = 0.443). Patients who underwent DC had a longer ICU stay (median [IQR] 240 [38–408] hours vs 24 [5–96] hours in non-DC patients, p = 0.002). At 90 days, 3 patients (4.1%) had obtained an mRS score of 0–2 and 10 patients (11.7%) an mRS score of 0–3. Patients who had improved functional outcome were younger (mRS score, OR 1.06, 95% CI 1.01–1.10, p = 0.012). Patients with a history of cancer had worse 90-day mRS scores (OR 8.49, 95% CI 1.54–159, p = 0.046). The rate of in-hospital mortality or discharge to hospice was significantly higher in the non-DC cohort (10 [38.5%] patients in the DC cohort vs 38 [64.4%] in the non-DC cohort, p = 0.026). Ninety days later, patients who underwent DC were more likely to have improved outcome (mRS mean rank 30.0 vs 40.0, p = 0.027). In multivariable analysis, history of cancer (OR 12.2, 95% CI 1.26–118, p = 0.031) and older age (OR 1.07, 95% CI 1.02–1.13, p = 0.011) increased the odds of worse mRS outcomes while DC did not (OR 1.34, 95% CI 0.357–5.03, p = 0.665). CONCLUSIONS DC after sICH did not improve functional outcome at 90 days according to multivariable analysis, although younger age and absence of previous cancer history were associated with improved outcomes.
AB - OBJECTIVE Symptomatic intracerebral hemorrhage (sICH) after stroke is a devastating neurological complication. Current guidelines support a “possible benefit” of decompressive craniectomy (DC) for large supratentorial sICH with significant mass effect. METHODS The authors conducted a retrospective study of 8 comprehensive stroke centers. They included all patients who sustained an sICH after acute ischemic stroke (AIS), as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST), from January 2016 to December 2020. They compared patients who underwent DC to those who were treated with standard medical treatment to measure functional outcome at 90 days, primarily as defined by the modified Rankin Scale (mRS) and secondarily by the Glasgow Outcome Scale–Extended (GOS-E). RESULTS Eighty-five patients were identified, 26 of whom (30.5%) underwent DC. Patients who underwent DC were younger (58 years [DC] vs 76 years [no DC], p < 0.001). No patient with a previous history of cancer underwent DC (n = 14, p = 0.004). Twenty-five patients (96.2%) in the DC group underwent thrombectomy versus 54 (91.5%) in the non-DC group (p = 0.443). Patients who underwent DC had a longer ICU stay (median [IQR] 240 [38–408] hours vs 24 [5–96] hours in non-DC patients, p = 0.002). At 90 days, 3 patients (4.1%) had obtained an mRS score of 0–2 and 10 patients (11.7%) an mRS score of 0–3. Patients who had improved functional outcome were younger (mRS score, OR 1.06, 95% CI 1.01–1.10, p = 0.012). Patients with a history of cancer had worse 90-day mRS scores (OR 8.49, 95% CI 1.54–159, p = 0.046). The rate of in-hospital mortality or discharge to hospice was significantly higher in the non-DC cohort (10 [38.5%] patients in the DC cohort vs 38 [64.4%] in the non-DC cohort, p = 0.026). Ninety days later, patients who underwent DC were more likely to have improved outcome (mRS mean rank 30.0 vs 40.0, p = 0.027). In multivariable analysis, history of cancer (OR 12.2, 95% CI 1.26–118, p = 0.031) and older age (OR 1.07, 95% CI 1.02–1.13, p = 0.011) increased the odds of worse mRS outcomes while DC did not (OR 1.34, 95% CI 0.357–5.03, p = 0.665). CONCLUSIONS DC after sICH did not improve functional outcome at 90 days according to multivariable analysis, although younger age and absence of previous cancer history were associated with improved outcomes.
KW - decompressive craniectomy
KW - hemorrhagic transformation
KW - intracerebral hemorrhage
KW - stroke
KW - vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=85214257656&partnerID=8YFLogxK
U2 - 10.3171/2024.4.JNS24318
DO - 10.3171/2024.4.JNS24318
M3 - Article
C2 - 39059427
AN - SCOPUS:85214257656
SN - 0022-3085
VL - 142
SP - 52
EP - 61
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 1
ER -