Radiological Parameters Predicting Clinical Outcome After Decompressive Hemicraniectomy in Malignant Ischemic Stroke

Abstract

Abstract INTRODUCTION Decompressive Hemicraniectomy (DH) is advocated as a lifesaving procedure in the management of patients with raised intracranial pressure due to malignant hemispheric infarction. The purpose of this study was to identify radiological parameters predicting the clinical outcome in patients with DH in large-territory ischemic stroke. METHODS Patients undergoing DH for malignant ischemic stroke were identified from electronic data base search (2011-2018). Logistic regression analysis evaluated the association of radiological variables with clinical outcome according to modified Rankin Scale (mRS) and Glasgow Outcome Scale Extended (GOSE) at 180 d. RESULTS Among 98 patients, 59 (60.2%) underwent CT scan post DH within 24 h. The median age of the included patients was 54 yr (29-80 yr), with males being predominant (89.8%). The mean NIHSS score for the included patients was 18.64 ± 6.8 (3-33), and majority of the patients (88.1%) had Middle Cerebral Artery Infarction (MCA). The mean mRS and GOSE at 180 d were 3.88 ± 1.39 and 4.12 ± 1.8, respectively. Univariate analysis identified a greater likelihood of good functional outcome in patients with ischemic stroke post DH on CT scan if there was absence of effacement of cortical sulci [OR 1.31: 95% CI: 1.28-1.39; P = .05], absence of effacement of basal cisterns [OR 3.4: 95% CI:1.36-8.5; P = .03], absence of hemorrhagic transformation in the infarct core [OR 2.3: 95% CI: 2.00-2.65; P = .03], or absence of compression of lateral ventricle [OR 1.25: 95% CI: 1.20-1.27; P = .05]. Furthermore, multivariate analysis found significant association in predicting good functional outcome with absence of effacement of cortical sulci [OR 2.01: 95% CI: 1.22-20.71; P = .02], absence of hemorrhagic transformation [OR 2.09: 95% CI: 1.01-27.30; P = .02], and absence of compression of lateral ventricles [OR 1.35: 95% CI: 1.28-18.4; P = .05], but absence of effacement of basal cisterns was not statistically significant (P = .36). CONCLUSION The radiographic features post DH in ischemic stroke predict the clinical outcome, thus stratify our management plan.