TY - JOUR T1 - Decompressive craniectomy after intra-arterial thrombolysis: safety and outcome JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 885 LP - 887 DO - 10.1136/jnnp.2009.198648 VL - 82 IS - 8 AU - Urs Fischer AU - Philipp Taussky AU - Jan Gralla AU - Marcel Arnold AU - Caspar Brekenfeld AU - Michael Reinert AU - Niklaus Meier AU - Marie-Luise Mono AU - Gerhard Schroth AU - Heinrich P Mattle AU - Krassen Nedeltchev Y1 - 2011/08/01 UR - http://jnnp.bmj.com/content/82/8/885.abstract N2 - 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. ER -