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Decompressive craniectomy after intra-arterial thrombolysis: safety and outcome
  1. Urs Fischer1,
  2. Philipp Taussky2,
  3. Jan Gralla3,
  4. Marcel Arnold1,
  5. Caspar Brekenfeld3,
  6. Michael Reinert2,
  7. Niklaus Meier1,
  8. Marie-Luise Mono1,
  9. Gerhard Schroth3,
  10. Heinrich P Mattle1,
  11. Krassen Nedeltchev1
  1. 1Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
  2. 2Department of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
  3. 3Department of Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Urs Fischer, Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland; urs.fischer{at}insel.ch

Abstract

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.

  • Intra-arterial thrombolysis
  • decompressive craniectomy
  • outcome
  • cerebrovascular
  • interventional
  • neurosurgery
  • stroke

https://doi.org/10.1136/jnnp.2009.198648

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval Ethics approval was provided by the University of Bern.

    • Provenance and peer review Not commissioned; externally peer reviewed.