BACKGROUND AND PURPOSE: We assessed whether the effects of surgical decompression for space-occupying hemispheric infarction, observed at 1 year, are sustained at 3 years. METHODS:Patients with space-occupying hemispheric infarction, who were enrolled in the Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial within 4 days after stroke onset, were followed up at 3 years. Outcome measures included functional outcome (modified Rankin Scale), death, quality of life, and place of residence. Poor functional outcome was defined as modified Rankin Scale >3. RESULTS: Of 64 included patients, 32 were randomized to decompressive surgery and 32 to best medical treatment. Just as at 1 year, surgery had no effect on the risk of poor functional outcome at 3 years (absolute risk reduction, 1%; 95% confidence interval, -21 to 22), but it reduced case fatality (absolute risk reduction, 37%; 95% confidence interval, 14-60). Sixteen surgically treated patients and 8 controls lived at home (absolute risk reduction, 27%; 95% confidence interval, 4-50). Quality of life improved between 1 and 3 years in patients treated with surgery. CONCLUSIONS: In patients with space-occupying hemispheric infarction, the effects of decompressive surgery on case fatality and functional outcome observed at 1 year are sustained at 3 years. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN94237756.
RCT Entities:
BACKGROUND AND PURPOSE: We assessed whether the effects of surgical decompression for space-occupying hemispheric infarction, observed at 1 year, are sustained at 3 years. METHODS:Patients with space-occupying hemispheric infarction, who were enrolled in the Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial within 4 days after stroke onset, were followed up at 3 years. Outcome measures included functional outcome (modified Rankin Scale), death, quality of life, and place of residence. Poor functional outcome was defined as modified Rankin Scale >3. RESULTS: Of 64 included patients, 32 were randomized to decompressive surgery and 32 to best medical treatment. Just as at 1 year, surgery had no effect on the risk of poor functional outcome at 3 years (absolute risk reduction, 1%; 95% confidence interval, -21 to 22), but it reduced case fatality (absolute risk reduction, 37%; 95% confidence interval, 14-60). Sixteen surgically treated patients and 8 controls lived at home (absolute risk reduction, 27%; 95% confidence interval, 4-50). Quality of life improved between 1 and 3 years in patients treated with surgery. CONCLUSIONS: In patients with space-occupying hemispheric infarction, the effects of decompressive surgery on case fatality and functional outcome observed at 1 year are sustained at 3 years. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN94237756.
Authors: Hormuzdiyar H Dasenbrock; Faith C Robertson; M Ali Aziz-Sultan; Donovan Guittieres; Rose Du; Ian F Dunn; William B Gormley Journal: Neurocrit Care Date: 2016-12 Impact factor: 3.210
Authors: Kevin N Sheth; Nils H Petersen; Ken Cheung; Jordan J Elm; Holly E Hinson; Bradley J Molyneaux; Lauren A Beslow; Gordon K Sze; J Marc Simard; W Taylor Kimberly Journal: Stroke Date: 2018-05-22 Impact factor: 7.914
Authors: Hormuzdiyar H Dasenbrock; David J Cote; Yuri Pompeu; Viren S Vasudeva; Timothy R Smith; William B Gormley Journal: BMC Neurol Date: 2017-06-26 Impact factor: 2.474
Authors: Haifa M Algethamy; Afnan Samman; Saleh S Baeesa; Mohammed A Almekhlafi; Yousef A Al Said; Ahmed Hassan Journal: Neurosciences (Riyadh) Date: 2017-07 Impact factor: 0.906