Kamran Saadat, Akhtar Naveed, Salam Abdul, Alboudi Ayman, Rashid Hiba, Kamran Kainat, Khan Rabia Ali, Mirza Mohsin Khalid, Ahmed Arsalan, Own Ahmed M A, Al Rukun Sohail, Inshasi Jihad, Deleu Dirk, Al Sulaiti Ghanim, Shuaib Ashfaq
Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar; Weill Cornell School of Medicine, Qatar.
Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar; Weill Cornell School of Medicine, Qatar.
J Stroke Cerebrovasc Dis. 2017 Oct;26(10):2306-2312. doi: 10.1016/j.jstrokecerebrovasdis.2017.05.018. Epub 2017 Jun 1.
The randomized trials showed improved outcome and reduced mortality in malignant middle cerebral artery (MMCA) undergoing Decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. Despite high prevalence of stroke, especially in younger individuals, high and short-term mortality from stroke in South Asian and Middle East, there is little published data on DHC in patients with MMCA stroke.
This is a retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale (mRS) and dichotomized as favorable (mRS ≤ 4) or unfavorable (mRS > 4), at 3 months.
In total, 137 patients underwent DHC. At 90 days, mortality was 16.8%; 61.3% of patients survived with an mRS of 4 or less and 38.7% had an mRS greater than 4. Age (55 years), diabetes (P = .004), hypertension (P = .021), pupillary abnormality (P = .048), uncal herniation (P = .007), temporal lobe involvement (P = .016), additional infarction (MCA + anterior cerebral artery, posterior cerebral artery) (P = .001), and infarction growth rates (P = .025) were significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation greater than 1 cm, and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome (P = .109).
Similar to the results of the studies from the West, DHC Improves functional outcome in predominantly South Asian patients with MMCA Stroke.
随机试验表明，在卒中发作48小时内接受去骨瓣减压术（DHC）的恶性大脑中动脉（MMCA）患者，其预后得到改善，死亡率降低。尽管卒中患病率很高，尤其是在年轻个体中，南亚和中东地区卒中的高死亡率和短期死亡率也很高，但关于MMCA卒中患者接受DHC的已发表数据很少。
这是一项回顾性、多中心横断面研究，采用改良Rankin量表（mRS）在3个月时测量DHC后的预后，并将其分为良好（mRS≤4）或不良（mRS>4）。
共有137例患者接受了DHC。在90天时，死亡率为16.8%；61.3%的患者存活且mRS为4或更低，38.7%的患者mRS大于4。在单因素分析中，年龄（55岁）、糖尿病（P = 0.004）、高血压（P = 0.021）、瞳孔异常（P = 0.048）、钩回疝（P = 0.007）、颞叶受累（P = 0.016）、额外梗死（大脑中动脉+大脑前动脉、大脑后动脉）（P = 0.001）和梗死增长率（P = 0.025）在预后不良的患者中显著更高。多因素分析显示，年龄、额外梗死、透明隔偏移大于1 cm和钩回疝与预后显著不良相关。手术时间对预后无影响（P = 0.109）。
与西方研究结果相似，DHC可改善以南亚为主的MMCA卒中患者的功能预后。
