Related Experiment Video
Updated: Jun 12, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Decompressive craniectomy after intra-arterial thrombolysis: safety and outcome
Urs Fischer1, Philipp Taussky, Jan Gralla
1Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland. urs.fischer@insel.ch
Insights
Decompressive craniectomy after intra-arterial thrombolysis for malignant middle cerebral artery stroke showed similar outcomes and complication rates compared to decompressive craniectomy without prior thrombolysis.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Malignant middle cerebral artery (MCA) stroke often requires decompressive craniectomy (DC).
- The role of intra-arterial thrombolysis (IAT) prior to DC in these cases is not well-established.
- Limited data exist on the safety and efficacy of combining IAT with DC for MCA stroke.
Purpose of the Study:
- To compare outcomes and complications in patients undergoing DC after IAT versus DC without prior IAT.
- To evaluate the impact of IAT on the effectiveness of DC for malignant MCA stroke.
- To identify factors influencing outcomes in patients treated with DC for MCA stroke.
Main Methods:
- Retrospective comparison of consecutive patients with MCA strokes.
- Patients were divided into two groups: those who underwent DC after IAT and those who underwent DC without prior thrombolysis.
- Outcomes were assessed at 3 months using the modified Rankin scale, along with mortality and complication rates.
Main Results:
- Fifteen of 30 patients undergoing DC for space-occupying edema after MCA stroke received prior IAT.
- Favorable outcomes (modified Rankin scale 0-3) were observed in 47% of IAT patients versus 27% of non-IAT patients (p=0.45).
- No significant differences in mortality or major complications were found between the groups. Older age and hypertension predicted unfavorable outcomes.
Conclusions:
- Decompressive craniectomy following intra-arterial thrombolysis does not increase complications compared to DC alone for malignant MCA stroke.
- The study found no significant difference in outcomes between patients who received IAT before DC and those who did not.
- IAT prior to DC may not alter the overall outcome or complication profile of this critical intervention.
Objectives:
Data on decompressive craniectomy (DC) after intra-arterial thrombolysis (IAT) for treatment of malignant middle cerebral artery (MCA) stroke are lacking.
Methods:
The authors compared consecutive patients with middle cerebral artery (MCA) strokes who underwent decompressive craniectomy (DC) after IAT with DC patients without prior thrombolysis.
Results:
Thirty of 2395 consecutive patients with acute ischaemic stroke or transient ischaemic attack were treated with DC because of space-occupying oedema 12-72 h after symptom onset. Fifteen patients underwent intra-arterial thrombolysis (IAT) prior to DC. Baseline characteristics did not differ between thrombolysed and non-thrombolysed patients except for lower National Institute of Health Stroke Scale score in non-thrombolysed patients (median National Institute of Health Stroke Scale 17 vs. 14, p=0.033). The outcome at 3 months was favourable (modified Rankin scale 0-3) in seven (47%) thrombolysed patients and in four (27%) non-thrombolysed patients (p=0.45). Mortality and major complications after DC did not differ between the two groups (p>0.05). Older age (p=0.037) and previous hypertension (p=0.047) independently predicted unfavourable outcome in DC patients, but not IAT prior DC.
Conclusions:
There was no difference of outcome of patients with DC with or without prior IAT. DC after IAT did not cause any more complications than DC without prior thrombolysis.
