Effect of Decompressive Craniectomy According to Location of Deep Intracerebral Hemorrhage: A SWITCH Trial Analysis.

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-10-17 DOI:10.1161/STROKEAHA.125.052460

Alexandros A Polymeris, Matthias F Lang, Arsany Hakim, Lukas Bütikofer, Christian Fung, Seraina Beyeler, Werner Z'Graggen, Daniel Strbian, Peter Vajkoczy, Gerrit A Schubert, Andreas Gruber, Dorothee Mielke, Roland Roelz, Bernhard Siepen, David J Seiffge, Magdy H Selim, Andreas Raabe, Jürgen Beck, Urs Fischer

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引用次数: 0

Abstract

Background: Decompressive craniectomy (DC) seemed to reduce the risk of death or profound disability (modified Rankin Scale score, 5-6) after deep intracerebral hemorrhage (ICH) by an absolute 13% (95% CI, 0%-26%) in the SWITCH trial (Swiss Trial of Decompressive Craniectomy versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage). Whether the effect of DC differs by ICH location is unknown.

Methods: Post hoc analysis of participants with supratentorial severe deep ICH from the intention-to-treat population of the SWITCH randomized controlled trial. We categorized ICH as involving (1) the basal ganglia (BG) alone, (2) BG and the posterior limb of the internal capsule (PLIC), or (3) BG, PLIC, and thalamus. We examined the interaction between ICH location and DC's effect on primary (modified Rankin Scale score, 5-6) and secondary outcomes (death; full modified Rankin Scale score range) at 180 days using unadjusted and adjusted logistic or survival models.

Results: Of 197 participants comprising the trial's intention-to-treat population, 184 were available for analysis (median age, 61 years; 59 women; 91 randomized to DC plus best medical treatment; and 93 to best medical treatment). ICH involved BG alone in 26 (14%), BG+PLIC in 94 (51%), and BG+PLIC+thalamus in 64 participants (35%). The marginal risk of the primary outcome after adjustment for age, ICH severity, and volume was lower with DC by 15.6% (95% CI, -49.2% to 18.1%) in participants with ICH of BG alone, by 11.4% (-29.3% to 6.6%) in those with ICH of BG+PLIC, and by 9% (-31% to 12.9%) in those with ICH of BG+PLIC+thalamus, without evidence for treatment-by-location interaction (P=0.95). Secondary outcome analyses yielded consistent results.

Conclusions: The potential benefits of DC seemed preserved regardless of the location of severe deep ICH.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02258919.

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根据深度脑出血的位置进行减压颅骨切除术的效果：一项SWITCH试验分析。

背景：在SWITCH试验（瑞士关于自发性幕上脑出血的减压颅切除术与最佳药物治疗的试验）中，减压颅切除术（DC）似乎可以将深度脑出血（ICH）后死亡或深度残疾的风险（改良Rankin评分，5-6）绝对降低13% （95% CI, 0%-26%）。DC的作用是否因脑出血部位而异尚不清楚。方法：对来自SWITCH随机对照试验意向治疗人群的幕上重度深部脑出血患者进行事后分析。我们将脑出血分类为：(1)仅涉及基底神经节（BG）， (2) BG和内囊后肢（PLIC），或(3)BG、PLIC和丘脑。我们使用未调整和调整的logistic或生存模型，检查了ICH位置和DC对180天主要（修改的Rankin量表评分，5-6）和次要结局（死亡；修改的Rankin量表评分范围）的影响之间的相互作用。结果：在197名包括试验意向治疗人群的参与者中，184名可用于分析（中位年龄61岁；59名女性；91名随机分配到DC加最佳药物治疗组；93名随机分配到最佳药物治疗组）。ICH仅涉及BG 26例（14%），BG+PLIC 94例（51%），BG+PLIC+丘脑64例（35%）。调整年龄、脑出血严重程度和体积后，主要结局的边际风险在单独有BG的脑出血患者中降低了15.6% (95% CI, -49.2%至18.1%)，在有BG+PLIC的脑出血患者中降低了11.4%(-29.3%至6.6%)，在有BG+PLIC+丘脑的脑出血患者中降低了9%(-31%至12.9%)，没有证据表明根据部位进行治疗的相互作用（P=0.95）。次要结果分析得出一致的结果。结论：DC的潜在益处似乎与严重深部脑出血的位置无关。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02258919。

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

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.