Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-06-09 DOI:10.1227/neu.0000000000003563

Elliot Pressman, Kunal Vakharia, Waldo R Guerrero, Mohammad-Mahdi Sowlat, Samantha Schimmel, Ilko Maier, Ansaar Raai, Pascal Jabbour, Joon-Tae Kim, Jonathan A Grossberg, Ali Alawieh, Stacey Q Wolfe, Robert M Stark, Marios-Nikos Psychogios, Edgar A Samaniego, Nitin Goyal, Justin Dye, Ali Alaraj, Shinichi Yoshimura, Mohamad Ezzeldin, David Fiorella, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Justin Mascitelli, Joshua Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Charles Matouk, Min S Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J Altschul, Christopher S Ogilvy, Roberto Crosa, Michael R Levitt, Benjamin Gory, Ramesh Grandhi, Alexandra R Paul, Peter Kan, Walter Casagrande, Shakeel Chowdhry, Michael F Stiefel, Alejandro M Spiotta, Maxim Mokin

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Abstract

Background and objectives: It remains unclear whether decompressive craniectomy (DC) is beneficial in patients who suffer symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke (AIS). We sought to study the effect of DC on functional outcomes in patients with sICH after AIS who underwent mechanical thrombectomy (MT).

Methods: Patients with AIS from anterior circulation large vessel occlusion who underwent MT and subsequently developed sICH were identified from the Stroke Thrombectomy and Aneurysm Registry database. The primary outcome was acceptable 90-day functional neurological outcome, defined as modified Rankin scale (mRS) 0-3. Multivariable logistic regression and propensity-score matching were used to identify and quantify risk factors.

Results: Of 464 patients identified with sICH after AIS after MT, 97 patients (20.9%) underwent DC. Patients who underwent DC were more likely to be female (P < .001), younger (P < .001), have a measured medical comorbidity, have higher baseline mRS (P = .02), and have higher-grade hemorrhages (P = .01). At 90 days, 14% of patients had the primary outcome of mRS 0-3 and 56% had died. The primary outcome was observed in 11 patients who underwent DC (11%) and 55 (15%) of those without DC (odds ratio [OR] 0.7, 95% CI 0.4-1.4, P = .40). DC did not affect mRS shift at 90 days (P = .10) but was associated with lower mortality (OR 0.5, 95% CI 0.3-0.8, P = .01). Multivariable analysis demonstrated that DC decreased the odds of primary outcome (adjusted OR 0.2, 95% CI 0.02-0.9, P = .045), but did not affect mortality (P = .94), mRS shift (P = .50), or length of stay (P = .90). Propensity-matched analysis similarly demonstrated that non-DC patients were more likely to achieve the primary outcome (24% vs 8%, P = .045).

Conclusion: In patients with sICH after AIS after MT, those selected for DC had less favorable outcomes and similar rates of mortality at 90 days.

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伤害大于帮助？急性缺血性卒中机械取栓后症状性脑出血患者的减压颅骨切除术：来自卒中取栓和动脉瘤登记的见解。

背景和目的：对于急性缺血性卒中（AIS）后出现症状性脑出血（sICH）的患者，减压颅骨切除术（DC）是否有益尚不清楚。我们试图研究DC对AIS后行机械取栓术（MT）的sICH患者功能结局的影响。方法：从卒中血栓切除术和动脉瘤登记数据库中确定前循环大血管闭塞的AIS患者，这些患者接受了MT并随后发展为sICH。主要转归为可接受的90天功能神经学转归，定义为改良Rankin量表（mRS） 0-3。采用多变量逻辑回归和倾向评分匹配来识别和量化危险因素。结果：在464例MT后AIS合并sICH患者中，97例（20.9%）行DC。接受DC的患者更可能是女性（P < 0.001）、年轻（P < 0.001）、有测量到的医学合并症、基线mRS较高（P = 0.02）和出血级别较高（P = 0.01）。90天时，14%的患者的主要结局为mRS 0-3, 56%的患者死亡。主要结局观察了11例DC患者（11%）和55例未DC患者（15%）（优势比[OR] 0.7, 95% CI 0.4-1.4, P = 0.40）。DC不影响90天的mRS移位（P = 0.10），但与较低的死亡率相关（OR 0.5, 95% CI 0.3-0.8, P = 0.01）。多变量分析表明，DC降低了主要结局的几率（调整OR为0.2,95% CI为0.02-0.9,P = 0.045），但不影响死亡率（P = 0.94）、mRS移位（P = 0.50）或住院时间（P = 0.90）。倾向匹配分析同样表明，非dc患者更有可能达到主要结局（24%对8%，P = 0.045）。结论：在MT后AIS后的sICH患者中，选择DC的患者预后较差，90天死亡率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.