Saadat Kamran1, Naveed Akhtar2, Abdul Salam3, Ayman Alboudi4, Hiba Rashid5, Kainat Kamran6, Rabia Ali Khan3, Mohsin Khalid Mirza3, Arsalan Ahmed7, Ahmed M A Own8, Sohail Al Rukun4, Jihad Inshasi4, Dirk Deleu2, Ghanim Al Sulaiti9, Ashfaq Shuaib10. 1. Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar; Weill Cornell School of Medicine, Qatar. Electronic address: skamranmd@hotmail.com. 2. Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar; Weill Cornell School of Medicine, Qatar. 3. Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar. 4. Rashid Hospital, Dubai, United Arab Emirates. 5. Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar. 6. Neuroscience-University of Illinois, Chicago, Illinois. 7. Shifa International Hospital, Islamabad, Pakistan. 8. Department of Radiology, Hamad Medical Corporation, Doha, Qatar. 9. Department of Neuroscience (Neurological Surgery), Hamad Medical Corporation, Doha, Qatar. 10. Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar; The Stroke Program, University of Alberta, Canada.
Abstract
BACKGROUND: The randomized trials showed improved outcome and reduced mortality in malignant middle cerebral artery (MMCA) undergoing Decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. Despite high prevalence of stroke, especially in younger individuals, high and short-term mortality from stroke in South Asian and Middle East, there is little published data on DHC in patients with MMCA stroke. METHODS: This is a retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale (mRS) and dichotomized as favorable (mRS ≤ 4) or unfavorable (mRS > 4), at 3 months. RESULTS: In total, 137 patients underwent DHC. At 90 days, mortality was 16.8%; 61.3% of patients survived with an mRS of 4 or less and 38.7% had an mRS greater than 4. Age (55 years), diabetes (P = .004), hypertension (P = .021), pupillary abnormality (P = .048), uncal herniation (P = .007), temporal lobe involvement (P = .016), additional infarction (MCA + anterior cerebral artery, posterior cerebral artery) (P = .001), and infarction growth rates (P = .025) were significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation greater than 1 cm, and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome (P = .109). CONCLUSIONS: Similar to the results of the studies from the West, DHC Improves functional outcome in predominantly South Asian patients with MMCA Stroke.
BACKGROUND: The randomized trials showed improved outcome and reduced mortality in malignant middle cerebral artery (MMCA) undergoing Decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. Despite high prevalence of stroke, especially in younger individuals, high and short-term mortality from stroke in South Asian and Middle East, there is little published data on DHC in patients with MMCA stroke. METHODS: This is a retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale (mRS) and dichotomized as favorable (mRS ≤ 4) or unfavorable (mRS > 4), at 3 months. RESULTS: In total, 137 patients underwent DHC. At 90 days, mortality was 16.8%; 61.3% of patients survived with an mRS of 4 or less and 38.7% had an mRS greater than 4. Age (55 years), diabetes (P = .004), hypertension (P = .021), pupillary abnormality (P = .048), uncal herniation (P = .007), temporal lobe involvement (P = .016), additional infarction (MCA + anterior cerebral artery, posterior cerebral artery) (P = .001), and infarction growth rates (P = .025) were significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation greater than 1 cm, and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome (P = .109). CONCLUSIONS: Similar to the results of the studies from the West, DHC Improves functional outcome in predominantly South Asian patients with MMCA Stroke.
Authors: Ana Lopez-de-Andres; Rodrigo Jimenez-Garcia; Valentín Hernández-Barrera; Isabel Jiménez-Trujillo; José M de Miguel-Yanes; David Carabantes-Alarcon; Javier de Miguel-Diez; Marta Lopez-Herranz Journal: Cardiovasc Diabetol Date: 2021-07-09 Impact factor: 9.951