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Updated: Mar 29, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Clinical value of the fibrosis-4 index in predicting decompressive craniectomy after mechanical thrombectomy in
Fatma Ebru Agül1, Halil Ay2, Yüksel Kablan2
1Department of Neurology, Gaziantep University Medicine Faculty, Gaziantep, Türkiye.
Background And Purpose:
Large artery occlusion (LAO) often leads to malignant middle cerebral artery infarction, for which mechanical thrombectomy (MT) is the standard treatment. However, successful reperfusion may result in ischemia/reperfusion injury, causing brain edema or hemorrhagic transformation. Decompressive craniectomy (DC) is a life-saving procedure used to manage intracranial hypertension and prevent brain herniation. Recent studies suggest that liver fibrosis may increase the risk of stroke, even after adjusting for conventional cardiovascular risk factors. The Fibrosis-4 (FIB-4) index - a simple, noninvasive marker of liver fibrosis calculated using age, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), and platelet count - may have clinical utility in this context. This study aimed to determine whether the FIB-4 index at admission can predict the need for DC in patients with LAO acute ischemic stroke undergoing MT.
Methods:
This retrospective study included patients who underwent MT at two comprehensive stroke centers in southern and eastern Turkey between January 2022 and December 2024. Patients were divided into two groups based on whether they received DC. The FIB-4 index was calculated using the formula: (ASAT × age) / (platelet count × √ALAT).
Results:
Patients who underwent DC were significantly older and had higher National Institutes of Health Stroke Scale scores, modified Rankin Scale (mRS) scores, systolic and diastolic blood pressures, FIB-4 index values, and rates of hemorrhagic transformation. Receiver operating characteristic analysis identified a FIB-4 cutoff value of 1.24 (area under the curve: 0.85), with 70% sensitivity and 93% specificity for predicting the need for decompressive surgery. Non-adjusted univariate logistic regression analysis showed that the FIB-4 index was a strong independent predictor of DC.
Conclusion:
The FIB-4 index emerged as a significant and independent prognostic marker for identifying patients at risk of requiring decompressive surgery following MT for acute ischemic stroke.
