Hyperdense middle cerebral artery sign predicts favorable outcome after decompressive craniectomy in patients with malignant middle cerebral artery infarction

2021 ◽  
pp. 028418512110358
Author(s):  
Zhihua Xu ◽  
Jinfeng Duan ◽  
Benqiang Yang ◽  
Xin Huang ◽  
Guobiao Liang ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Characteristic Curve ◽  
Clinical Information ◽  
Favorable Outcome ◽  
Middle Cerebral Artery Infarction ◽  
Life Threatening ◽  
Hyperdense Middle Cerebral Artery

Background Malignant middle cerebral artery infarction (MMI) is a life-threatening cerebral vascular event. Early decompressive craniectomy (DC) has proven to be an effective treatment strategy. However, the ideal candidate for DC continues to be debated. Purpose To investigate whether a hyperdense middle cerebral artery sign (HMCAS) provides prognostic value after DC in patients with MMI. Material and Methods We reviewed clinical information and radiological parameters on computed tomography of 42 patients with MMI who underwent DC. Functional outcome was assessed according to the modified Rankin scale (mRS) at three months as follows: favorable outcome (mRS ≤ 4) versus unfavorable outcome (mRS > 4). Logistic regression analysis was used to identify predictors of functional outcome after DC in patients with MMI. Results Age (odds ratio [OR] = 0.87; 95% confidence interval [CI] = 0.78–0.97; P = 0.014) and HMCAS (OR = 7.40; 95% CI = 1.35–40.48; P = 0.021) were associated with functional outcome. The area under the receiver operating characteristic curve for predicting favorable outcome using the combination of age and HMCAS was 0.882, and the sensitivity and specificity were 0.947 and 0.696, respectively. Conclusion Patients with MMI with HMCAS, as well as younger patients, often showed a favorable outcome after DC in this study.

scholarly journals Decompressive craniectomy for malignant middle cerebral artery infarction: Impact on mortality and functional outcome

2014 ◽  
Vol 5 (1) ◽  
pp. 102 ◽  
Author(s):  
Mohammed AzmanMohammad Raffiq ◽  
Mohammed SaffariMohammad Haspani ◽  
Regunath Kandasamy ◽  
JafriMalin Abdullah
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Middle Cerebral Artery Infarction

Abstract P687: Acute Kidney Failure in Patients With Malignant Middle Cerebral Artery Infarction Undergoing Osmotherapy With Mannitol

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Haidar Moustafa ◽  
Daniela Schoene ◽  
Lars-Peder Pallesen ◽  
Alexandra Prakapenia ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Kidney Failure ◽  
Acute Kidney Failure ◽  
Hospital Death ◽  
Multivariable Model ◽  
Middle Cerebral Artery Infarction ◽  
Malignant Mca Infarction

Introduction: To explore kidney safety profile of osmotic diuretic mannitol in patients with malignant middle cerebral artery (MCA) infarction. Methods: We analyzed data from consecutive patients with malignant MCA infarction (01/2008-12/2017). Malignant MCA infarction was defined according to clinical and radiographic DESTINY criteria. Clinical and laboratory variables were collected for all patients. We compared clinical endpoints including acute kidney failure (AKF; according to Kidney Disease: Improving Global Outcomes [KDIGO] definition) and hemodialysis between patients who received mannitol and those who did not. Multivariable model was built to explore predictor variables of AKF, in-hospital death and functional outcome at discharge. Results: Overall, 228 patients with malignant MCA infarction were analyzed: median age 67 years (IQR, 56-76), 58% men, median NIHSS 23 (17-32) points. Decompressive craniectomy was performed in 103/228 (45.2%) patients. Mannitol was administered in 100/228 (43.9%) patients over an average of 85 (30.3-139.3) hours. Average dosage was 700 (250-1050) g. Patients treated with mannitol more frequently suffered from AKF (40% vs. 7.9%; p<0.0001) and needed hemodialysis (7.4% vs. 0.9%; p=0.024) than patients without mannitol. At discharge, kidney function completely recovered in 38.5% and 20%, respectively (p=0.459). In multivariable model adjusted for age, history of chronic kidney disease, nephrotoxic premedication, admission systolic blood pressure, concurrent urinary tract infection, contrast agent exposure and peak osmolality, mannitol therapy emerged as single predictor of AKF (OR 4.14, 95%CI 1.2-14.2; p=0.024). Neither AKF nor mannitol therapy was associated with in-hospital death or short-term functional outcome (p>0.05). Conclusions: Acute kidney failure appears to be a frequent complication of osmotic diuretic mannitol in patients with malignant MCA infarction. Given the lack of evidence supporting effectiveness of mannitol in these patients, its use should be carefully considered.

scholarly journals Outcome After Decompressive Craniectomy for Middle Cerebral Artery Infarction: Timing of the Intervention

Neurosurgery ◽  
2020 ◽  
Vol 86 (3) ◽  
pp. E318-E325 ◽  
Author(s):  
Taco Goedemans ◽  
Dagmar Verbaan ◽  
Bert A Coert ◽  
Bertjan Kerklaan ◽  
René van den Berg ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Meta Analysis ◽  
Unfavorable Outcome ◽  
Stroke Onset ◽  
Middle Cerebral Artery Infarction ◽  
Randomized Controlled ◽  
Current Guidelines ◽  
Hemispheric Infarct

Abstract BACKGROUND Based on randomized controlled trials (RCTs), clinical guidelines for the treatment of space-occupying hemispheric infarct employ age (≤60 yr) and time elapsed since stroke onset (≤48 h) as decisive criteria whether to perform decompressive craniectomy (DC). However, only few patients in these RCTs underwent DC after 48 h. OBJECTIVE To study the association between the timing of DC and (un)favorable outcome in patients with space-occupying middle cerebral artery (MCA) infarct undergoing DC. METHODS We performed a single-center cohort study from 2007 to 2017. Unfavorable outcome at 1 yr was defined as a Glasgow outcome scale 1 to 3. Additionally, we systematically reviewed the literature up to November 2018, including studies reporting on the timing of DC and other predictors of outcome. We performed Firth penalized likelihood and random-effects meta-analysis with odds ratio (OR) on unfavorable outcome. RESULTS A total of 66 patients were enrolled. A total of 26 (39%) patients achieved favorable and 40 (61%) unfavorable outcomes (13 [20%] died). DC after 48 h since stroke diagnosis did not significantly increase the risk of unfavorable outcome (OR 0.8, 95% CI 0.3-2.3). Also, in the meta-analysis, DC after 48 h of stroke onset was not associated with a higher risk of unfavorable outcome (OR 1.11; 95% CI 0.89-1.38). CONCLUSION The outcome of DC performed after 48 h in patients with malignant MCA infarct was not worse than the outcome of DC performed within 48 h. Contrary to current guidelines, we, therefore, advocate not to set a restriction of ≤48 h on the time elapsed since stroke onset in the decision whether to perform DC.

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