Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery 2

2012 ◽  
Author(s):  
Eric Juettler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Surgery ◽  
Malignant Infarction

scholarly journals Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY)

Stroke ◽  
2007 ◽  
Vol 38 (9) ◽  
pp. 2518-2525 ◽  
Author(s):  
Eric Jüttler ◽  
Stefan Schwab ◽  
Peter Schmiedek ◽  
Andreas Unterberg ◽  
Michael Hennerici ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Surgery ◽  
Malignant Infarction

DESTINY II: Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery II

2011 ◽  
Vol 6 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Eric Jüttler ◽  
Julian Bösel ◽  
Hemasse Amiri ◽  
Petra Schiller ◽  
Ronald Limprecht ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Surgery ◽  
Malignant Infarction

Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011987
Author(s):  
Dominik Lehrieder ◽  
Katharina Layer ◽  
Hans-Peter Müller ◽  
Viktoria Rücker ◽  
Jan Kassubek ◽  
...  
Keyword(s):  
Infarct Size ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Randomized Trials ◽  
Infarct Volume ◽  
Unfavorable Outcome ◽  
Inclusion Criteria ◽  
Younger Patients ◽  
Malignant Infarction ◽  
The Impact

ObjectiveTo determine the impact of infarct volume before hemicraniectomy in malignant middle cerebral artery infarction (MMI) as an independent predictor for patient selection and outcome prediction, we retrospectively analyzed data of 140 patients from a prospective multi-center study.MethodsPatients from the DESTINY-Registry that underwent hemicraniectomy after ischemic infarction of >50% of the middle cerebral artery territory were included. Functional outcome according to the modified Rankin Scale (mRS) was assessed at 12 months. Unfavorable outcome was defined as mRS 4-6. Infarct size was quantified semi-automatically from computed tomography or magnetic resonance imaging before hemicraniectomy. Subgroup analyses in patients fulfilling inclusion criteria of randomized trials in younger patients (age≤60y) were predefined.ResultsAmong 140 patients with complete datasets (34% female, mean (SD) age 54 (11) years), 105 (75%) had an unfavorable outcome (mRS > 3). Mean (SD) infarct volume was 238 (63) ml. Multivariable logistic regression identified age (OR 1.08 per 1 year increase; 95%-CI 1.02-1.13; p=0.004), infarct size (OR 1.27 per 10ml increase; 95%-CI 1.12-1.44; p<0.001) and NIHSS (OR 1.10; 95%-CI 1.01-1.20; p=0.030) before hemicraniectomy as independent predictors for unfavorable outcome. Findings were reproduced in patients fulfilling inclusion criteria of randomized trials in younger patients. Infarct volume thresholds for prediction of unfavorable outcome with high specificity (94% in overall cohort and 92% in younger patients) were more than 258 ml before hemicraniectomy.ConclusionOutcome in MMI strongly depends on age and infarct size before hemicraniectomy. Standardized volumetry may be helpful in the process of decision making concerning hemicraniectomy.

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