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Risk factors for decompressive craniectomy after endovascular treatment in acute ischemic stroke

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Abstract

Endovascular treatment (EVT) is safe and effective for acute ischemic stroke (AIS) caused by large artery occlusion in the anterior circulation. However, some patients require decompressive craniectomy (DC), despite having undergone a timely EVT. This study aimed to evaluate the risk factors for subsequent DC after EVT. This retrospective cohort study comprised 138 patients who received EVT between April 2015 and June 2019 at our center. The need for subsequent DC was defined as cerebral edema or/and hemorrhagic transformation caused by large ischemic infarction, with a ≥ 5-mm midline shift and clinical deterioration after EVT. The relationship between risk factors and DC after EVT was assessed via univariate and multivariable logistic regression. Thirty (21.7%) patients required DC. These patients tended to have atrial fibrillation (P = 0.037), sedation (P = 0.049), mechanical ventilation (P = 0.008), poorer collateral circulation (P = 0.003), a higher baseline National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001), heavier thrombus burden (P < 0.001), a lower baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (P < 0.001), and unsuccessful recanalization (P < 0.001). In the multivariate analysis, higher baseline NIHSS score [odds ratio (OR), 1.17; 95% confidence interval (CI), 1.03–1.32], heavier thrombus burden [OR, 1.35; 95% CI, 1.02–1.79], baseline ASPECTS ≤ 8 [OR, 7.41; 95% CI, 2.43–22.66], and unsuccessful recanalization [OR, 7.49; 95% CI, 2.13–26.36] were independent risk factors for DC after EVT. DC remains an essential treatment for some AIS patients after EVT, especially those with higher baseline NIHSS scores, heavier thrombus burden, baseline ASPECTS ≤ 8, and unsuccessful recanalization.

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References

  1. Hacke W, Schwab S, Horn M, Spranger M, DeGeorgia M, von Kummer R (1996) ‘Malignant’ middle cerebral artery infarction: clinical course and prognostic signs. Arch Neurol 53(4):309–315

    Article  CAS  PubMed  Google Scholar 

  2. Gupta R, Connolly ES, Mayer S, Elkind MS (2004) Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 35(2):539–543

    Article  PubMed  Google Scholar 

  3. Juttler E, Schwab S, Schmiedek P et al (2007) Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke 38(9):2518–2525

    Article  PubMed  Google Scholar 

  4. Lin T-K, Chen S-M, Huang Y-C, Chen P-Y, Chen M-C, Tsai H-C, Lee T-H, Chen K-T, Lee M-H, Yang J-T, Huang K-L (2016) The outcome predictors of malignant large infarction and the functional outcome of survivors following decompressive craniectomy. World Neurosurg 93:133–138

    Article  PubMed  Google Scholar 

  5. Berkhemer OA, Fransen PS, Beumer D, van den Berg L, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen M, Staals J, Hofmeijer J, van Oostayen J, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk L, Kappelle LJ, Lo RH, van Dijk E, de Vries J, de Kort PL, van Rooij W, van den Berg J, van Hasselt B, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog H, Gerrits DG, van den Berg-Vos R, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam W, Roos YB, van der Lugt A, van Oostenbrugge R, Majoie CB, Dippel DW, MR CLEAN Investigators (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20

    Article  PubMed  Google Scholar 

  6. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM, EXTEND-IA Investigators (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11):1009–1018

    Article  CAS  PubMed  Google Scholar 

  7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD (2015) Randomized assessment of rapid endo-vascular treatment of ischemic stroke. N Engl J Med 372:1019–1030

    Article  CAS  PubMed  Google Scholar 

  8. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372(24):2296–2306

    Article  CAS  PubMed  Google Scholar 

  9. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372(24):2285–2295

    Article  CAS  PubMed  Google Scholar 

  10. Hao YG, Yang D, Wang HM et al (2017) Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke. Stroke 48(5):1203–1207

    Article  PubMed  Google Scholar 

  11. Mokin M, Abou-Chebl A, Castonguay AC, Nogueira RG, English JD, Farid H, Gupta R, Martin C, Holloway WE, Haussen DC, Mueller-Kronast N, Zaidat OO (2019) Real-world stent retriever thrombectomy for acute ischemic stroke beyond 6 hours of onset: analysis of the NASA and TRACK registries. J Neurointerv Surg 11(4):334–337

    Article  PubMed  Google Scholar 

  12. Park JS, Lee JM, Kwak HS, Chung GH (2019) Predictive value of CT angiography source image ASPECTS in patients with anterior circulation acute ischemic stroke after endovascular treatment: ultimate infarct size and clinical outcome. J Neurointerv Surg 11(4):342–346

    Article  PubMed  Google Scholar 

  13. Kondziella D, Cortsen M, Eskesen V, Hansen K, Holtmannspötter M, Højgaard J, Stavngaard T, Søndergaard H, Wagner A, Welling KL (2013) Update on acute endovascular and surgical stroke treatment. Acta Neurol Scand 127(1):1–9

    Article  CAS  PubMed  Google Scholar 

  14. Brott T, Adams HP Jr, Olinger CP et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  PubMed  Google Scholar 

  15. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Aspects study group. Alberta stroke programme early CT score. Lancet 355:1670–1674

    Article  CAS  PubMed  Google Scholar 

  16. Zaidat OO, Yoo AJ, Khatri P et al (2013) Cerebral angiographic revascularization grading (CARG) collaborators; STIR revascularization working group; STIR thrombolysis in cerebral infarction (TICI) task force: recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44:2650–2663

    Article  PubMed  PubMed Central  Google Scholar 

  17. Puetz V, Dzialowski I, Hill MD et al (2008) Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. Stroke 3:230–236

    Article  Google Scholar 

  18. Castro P, Azevedo E, Serrador J, Rocha I, Sorond F (2017) Hemorrhagic transformation and cerebral edema in acute ischemic stroke: link to cerebral autoregulation. J Neurol Sci 372:256–261

    Article  PubMed  Google Scholar 

  19. Riedel CH, Zimmermann P, Jensen-Kondering U, Stingele R, Deuschl G, Jansen O (2011) Successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke 42:1775–1777

    Article  PubMed  Google Scholar 

  20. Flottmann F, Leischner H, Broocks G et al (2018) Recanalization rate per retrieval attempt in mechanical thrombectomy for acute ischemic stroke. Stroke 49:2523–2525

    Article  PubMed  Google Scholar 

  21. Kamran S, Salam A, Akhtar N, D'Soza A, Shuaib A (2019) Predictors of decompressive hemicraniectomy in malignant middle cerebral artery stroke. Neurosurg Rev 42(1):175–181

    Article  PubMed  Google Scholar 

  22. Hofmeijer J, Kappelle LJ, Algra A et al (2009) Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8:326–333

    Article  PubMed  Google Scholar 

  23. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W, DECIMAL, DESTINY, and HAMLET investigators (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222

    Article  PubMed  Google Scholar 

  24. Chen C-C, Cho D-Y, Tsai S-C (2007) Outcome and prognostic factors of decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Chin Med Assoc 70(2):56–60

    Article  PubMed  Google Scholar 

  25. Frank JI, Schumm LP, Wroblewski K, Chyatte D, Rosengart AJ, Kordeck C, Thisted RA, HeADDFIRST Trialists, Bernardini G, Andrefsky J, Krieger D, Elkind M, Coplin W, Graffagnino C, Biller J, Wang D, Cruz-Flores S, Brock D, Demchuk A, Verro P, Frank J, Woo D, Suarez J, Pettigrew C, LaMonte M (2014) Hemicraniectomy and durotomy upon deterioration from infarction-related swelling trial. Stroke 45(3):781–787

    Article  PubMed  PubMed Central  Google Scholar 

  26. Beez T, Steiger HJ (2018) Impact of randomized controlled trials on neurosurgical practice in decompressive craniectomy for ischemic stroke. Neurosurg Rev 42(1):133–137

    Article  PubMed  Google Scholar 

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Funding

This paper was supported by the Clinical Research Program of Shantou Central Hospital.

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Authors and Affiliations

  1. Department of Neurosurgery, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, 114 Waima Road, Shantou, 515041, Guangdong, China

    Guoyi Peng, Mingfa Liu, Haixiong Xu & Chuwei Cai

  2. Department of Neurology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, 114 Waima Road, Shantou, 515041, Guangdong, China

    Chuming Huang & Chukai Xu

  3. Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China

    Weiqiang Chen

  4. Department of Intervention Neuroradiology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, 114 Waima Road, Shantou, 515041, Guangdong, China

    Chuwei Cai

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  1. Guoyi Peng
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  2. Chuming Huang
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Correspondence to Haixiong Xu or Chuwei Cai.

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This study was approved by the Ethics Committee of Shantou Central Hospital (2019-001).

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Peng, G., Huang, C., Chen, W. et al. Risk factors for decompressive craniectomy after endovascular treatment in acute ischemic stroke. Neurosurg Rev 43, 1357–1364 (2020). https://doi.org/10.1007/s10143-019-01167-4

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  • DOI: https://doi.org/10.1007/s10143-019-01167-4

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