Surgical intervention for prevent post-stroke malignant cerebral edema, clinical beneficial outcome aspects.
Keywords:
Malignant cerebral edema, Acute ischemic strokes, decompressive craniectomy, modified Rankin ScaleAbstract
Background: Acute ischemic strokes can develop post-stroke malignant cerebral edema. Surgical intervention known as decompressive craniectomy (DC) can decrease mortality but there is not evidence support for clinical beneficial outcome. The aim of this study assess beneficial outcome in surgical intervention for prevent post-stroke malignant cerebral edema.
Methods: Non-randomized, prospective, observational cohort study from 2016 to 2021 in 243 Subjects with acute ischemic stroke involving the middle cerebral, internal carotid artery, or both. Analyses of parameters affecting clinical beneficial outcome according to the modified Rankin Scale (mRS) at 3 and 6 months follow up were performed.
Results: Risk factors after multivariate analysis were onset to DC, tobacco use, NIHSS at admission, peripheral arterial occlusive disease, diabetes mellitus, body mass index (BMI), coronary artery disease, age more than 70 year and left side large-territory infarction. Age ≤ 71 year (AUC=0.955, p-value <0.001 accuracy 89.7%), onset to DC ≤ 9 hours (AUC
=0.824, p-value <0.001 accuracy 78.8%), volume of infarction ≤ 155 cm3 (AUC =0.939, p-value <0.001 accuracy 93.6%) and ASPECT score ≥ 6 (AUC = 1, p-value <0.001 accuracy 100%) were significantly parameters affecting clinical beneficial outcome.
Conclusion: Surgical intervention for prevent post-stroke malignant cerebral edema, age ≤ 71 years, onset to DC ≤ 9 hours, volume of infarction ≤ 155 cm3 and ASPECT score ≥ 6 associated with clinical beneficial outcome.
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