Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
Weill Cornell-School of Medicine, Ar-Rayyan, Qatar.
Transl Stroke Res. 2018 Dec;9(6):600-607. doi: 10.1007/s12975-018-0616-0. Epub 2018 Mar 6.
In patients with malignant middle cerebral artery (MMCA) stroke, a vital clinically relevant question is determination of the speed with which infarction evolves to select the time for decompressive hemicraniectomy [DHC]. A retrospective, multicenter cross-sectional study of patients referred for DHC, based on the criteria of randomized controlled trials, was undertaken to identify factors for selecting the timing of DHC in MMCA stroke, stratified by time [< 48, 48-72, > 72 h]. Infarction volume and infarct growth rate [IGR] were measured on all CT scans. One hundred eighty-two patients [135 underwent DHC and 47 survived without DHC] were included in the analysis. After multivariate adjustment, factors showing the strongest independent association with DHC were patients < 55 years of age, septum pellucidum deviation, temporal lobe involvement, MCA with additional infarcts, and IGR on second CT. Of the five factors identified, different combinations of determining factors were observed in each subgroup. Both first and second IGRs were highest in the < 48, 48-< 72, and > 72 h [p < 0.001]. Patients who survived without surgery had the slowest IGRs. There was no association between time to DHC and infarct volume, although infarct volume was lower in patients who survived without DHC compared to the DHC subgroups. We identify the major risk factors associated with DHC in time-stratified subgroups of patients with MMCA. Evaluation of IGRs between the first and second scan and when possible second and third scan can help in selecting the timing of hemicraniectomy.
在恶性大脑中动脉（MMCA）卒中患者中，一个至关重要的临床相关问题是确定梗死演变的速度，以便选择去骨瓣减压术（DHC）的时机。进行了一项回顾性、多中心、横断面研究，根据随机对照试验的标准，对因 MMCA 卒中而行 DHC 的患者进行研究，以确定影响 DHC 时机的因素，并按时间进行分层[<48、48-72、>72 h]。在所有 CT 扫描中测量梗死体积和梗死生长率（IGR）。共纳入 182 例患者[135 例行 DHC，47 例未行 DHC 存活]进行分析。经多变量调整后，与 DHC 有最强独立关联的因素为年龄<55 岁、透明隔偏移、颞叶受累、MCA 伴额外梗死和第二次 CT 的 IGR。在确定的五个因素中，不同的组合在每个亚组中都有不同。首次和第二次 IGR 在<48、48-<72 和>72 h 时间内最高[p<0.001]。未手术存活的患者 IGR 最慢。虽然与 DHC 亚组相比，未行 DHC 存活的患者梗死体积较低，但 DHC 时间与梗死体积之间无关联。我们确定了 MMCA 患者时间分层亚组中与 DHC 相关的主要危险因素。评估第一次和第二次扫描之间以及可能的第二次和第三次扫描之间的 IGR 有助于选择去骨瓣减压术的时机。
