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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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The malignant stroke indicator is an early indicator of malignant ischemic stroke requiring decompressive

Xenia Hautmann1,2, Ala Jamous3, Ilko Maier4

  • 1Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany.

Scientific Reports
|March 4, 2025
PubMed

Insights

A new Malignant Stroke Indicator (MSI) score helps identify patients needing decompressive craniectomy (DHC) for malignant ischemic stroke. The MSI score accurately predicts the likelihood of requiring this life-saving intervention.

Area of Science:

  • Neurology
  • Neurosurgery
  • Stroke Medicine

Background:

  • Malignant ischemic stroke poses a significant mortality risk.
  • Early identification of patients requiring decompressive craniectomy (DHC) is crucial but lacks clear criteria.
  • Developing a predictive tool for DHC necessity is vital for timely intervention.

Purpose of the Study:

  • To develop and validate a scoring system for predicting the need for decompressive craniectomy (DHC) in patients with ischemic stroke.
  • To identify key clinical and radiological parameters associated with malignant stroke progression requiring DHC.
  • To create a Malignant Stroke Indicator (MSI) score for early risk stratification.

Main Methods:

  • Retrospective observational study analyzing a cohort of 534 ischemic stroke patients (2010-2021).
  • Clinical and radiological parameters were assessed using univariate and multivariate regression analyses.
  • A Malignant Stroke Indicator (MSI) score was constructed based on age, midline shift, recanalization status, basal cistern effacement, and CBV ASPECTS.

Main Results:

  • The MSI score incorporates age < 70 years (7 pts), midline shift (≤6 pts), unsuccessful recanalization TICI < 2b (6 pts), basal cistern effacement (4 pts), and CBV ASPECTS < 6 (3 pts).
  • An MSI score cutoff of 9 demonstrated high predictive power for DHC necessity (AUC 0.90, p < 0.0001).
  • Patients with an MSI score ≥ 9 had a 22.9-fold increased probability of requiring DHC (p < 0.0001).

Conclusions:

  • The Malignant Stroke Indicator (MSI) score is a promising tool for predicting the need for decompressive craniectomy in high-risk ischemic stroke patients.
  • The MSI score facilitates early identification of individuals likely to develop malignant stroke requiring DHC.
  • Further validation in external cohorts is recommended to confirm the generalizability of the MSI score.

Keywords:
Brain edemaDecompressive hemicraniectomyMalignant ischemic stroke

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