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Updated: Sep 10, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular Thrombectomy Combined with Decompressive Craniectomy for Malignant Anterior Circulation Large Vessel
Wenchao Lu1, Nan Wu1, Yanchang Qin1
1Department of Neurosurgery, Xi'an Daxing Hospital, Xi'an, Shaanxi, China.
Objective:
To evaluate the efficacy of endovascular thrombectomy (EVT) combined with decompressive craniectomy (DC) in patients with malignant anterior circulation large vessel occlusion (MACLVO) stroke.
Methods:
We retrospectively analyzed clinical data from 189 MACLVO stroke patients who received EVT with or without DC. Outcomes included onset to treatment time, National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Scores, neurointensive care unit (NICU) stay, and 90-day modified Rankin Scale score. Univariate and multivariate logistic regressions were performed to identify predictors of mortality and prognosis.
Results:
The EVT-DC group had significantly longer onset to treatment time, higher NIHSS, and lower Alberta Stroke Program Early CT Scores preoperatively. Despite no difference in total hospital stay, NICU duration was shorter in the EVT-DC group (11.89 ± 1.76 vs. 12.53 ± 2.06 days, P = 0.031). The 90-day mortality was significantly lower in the EVT-DC group (33.80% vs. 68.65%, P < 0.001). Although favorable outcomes among survivors were more common with EVT-DC (12.68% vs. 1.69%), the difference was not statistically significant (P = 0.064). Multivariate logistic regression analysis showed EVT combined with DC and preoperative NIHSS score were independent predictors of both mortality (odds ratio [OR = 1.614, P = 0.035; OR = 0.064, P < 0.001) and favorable prognosis (OR = 3.030, P = 0.049; OR = 0.004, P = 0.003).
Conclusions:
EVT combined with DC reduces mortality and NICU stay in MACLVO stroke, with a potential trend toward better functional outcomes. However, severe disability remains common, underscoring the need for shared decision-making with patients and families.
