Decompressive Craniectomy in Patients with Malignant Stroke with Additional Vascular Territory

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Decompressive craniectomy (DC) significantly reduces mortality and disability after malignant stroke.
• DC is a vital life-saving procedure, particularly where mechanical thrombectomy access is limited.
• Outcomes of DC in malignant stroke with concomitant anterior or posterior cerebral artery occlusion require further investigation.

Purpose of the Study:

• To compare outcomes of decompressive craniectomy in malignant stroke patients with and without additional vascular territory involvement.
• To identify factors influencing mortality and disability after decompressive craniectomy in this patient cohort.

Main Methods:

• Retrospective cohort study (January 2010 - December 2022) of patients undergoing decompressive craniectomy.
• Comparison of outcomes (mortality, modified Rankin Score at 3 months) between patients with and without additional vascular territory involvement.
• Analysis of independent variables including demographics, stroke severity scores, surgical timing, and imaging findings.

Main Results:

• Of 86 patients, 61 had no additional territory involvement and 25 had additional involvement.
• Patients with additional territory involvement had lower Glasgow Coma Scale scores and higher National Institutes of Health Stroke Scale scores.
• No significant differences in mortality or severe disability were observed between the groups, even after adjustment. Age was the only predictor of increased mortality.

Conclusions:

• Decompressive craniectomy for malignant stroke yields similar outcomes whether or not additional vascular territories are involved.
• Age is a significant predictor of mortality in patients undergoing decompressive craniectomy for malignant stroke.
• The findings support the continued use of decompressive craniectomy in selected malignant stroke cases, irrespective of territory involvement.