Abstract
Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.
Highlights
Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments
This study aimed to evaluate the functional outcome of patients with malignant ischemic stroke treated in a neurological emergency center in the Northeast of Brazil, submitted to DC surgery or not. This was a prospective cohort study, in which all patients with MCA malignant ischemic stroke treated by the neurological emergency service of the General Hospital of Fortaleza City, Ceará State, Brazil, from November 1st, 2015 to December 30th, 2016, were evaluated
The initial sample of 29 patients was divided into two groups: 10 patients who were treated with DC surgery and 19 who continued receiving gold-standard conservative treatment in the stroke unit, with the support of the specialized multidisciplinary team, including neurologists, nurses, physiotherapists, occupational therapists, speech therapists and dentists
Summary
Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); with no statistical significance. The proportion of patients with moderate to severe disability (mRS 4–5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability
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