Kamran Saadat, Salam Abdul, Akhtar Naveed, D'soza Atlantic, Shuaib Ashfaq
Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
Weill Cornell-Medicine, Ar-Rayyan, Qatar.
Neurosurg Rev. 2019 Mar;42(1):175-181. doi: 10.1007/s10143-018-0974-9. Epub 2018 Apr 12.
Identification of factors in malignant middle cerebral artery (MMCA) stroke patients that may be useful in selecting patients for DHC. This study was a retrospective multicenter study of patients referred for DHC based on the criteria of the randomized control trials of DHC in MMCA stroke. Demographic, clinical, and radiology data were analyzed. Patients who underwent DHC were compared to those who survived without surgery. Two hundred three patients with MMCA strokes were identified: 137 underwent DHC, 47 survived without DHC, and 19 refused surgery and died. Multivariate analysis identified the following factors determining DHC in MMCA stroke: age < 55 years (OR 8.5, 95% CI 3.3-22.1, P < 0.001), MCA with involvement of additional vascular territories (anterior cerebral artery, posterior cerebral artery (OR 4.8, 95% CI 1.5-14.9, P = 0.007), septum pellucidum displacement ≥ 7.5 mm (OR 4.8, 95% CI 1.9-11.7, P = 0.001), diabetes (OR 3.7, 95% CI 1.3-10.6, P = 0.012), infarct growth rate (IGR) ml/h (OR 1.11, 95% CI 1.02-1.2, P = 0.015), and temporal lobe involvement (OR 2.5, 95% CI 1.01-6.1, P = 0.048). The internal validation of the multivariate logistic regression model using bootstrapping analysis showed marginal bias. Among patients with MMCA infarctions, an increased possibility of DHC is associated with younger age, MCA with additional infarction, septum pellucidum deviation of > 7.5 mm, diabetes, IGR, and temporal lobe involvement. The presence of these risk factors identifies those MMCA stroke patients who may require DHC. Bootstrapping analysis indicated the model is good enough to predict the outcome in general population.
识别恶性大脑中动脉（MMCA）卒中患者中可能有助于选择进行去骨瓣减压术（DHC）患者的因素。本研究是一项回顾性多中心研究，研究对象为根据MMCA卒中DHC随机对照试验标准转诊进行DHC的患者。分析了人口统计学、临床和放射学数据。将接受DHC的患者与未接受手术而存活的患者进行比较。共确定了203例MMCA卒中患者：137例接受了DHC，47例未接受DHC而存活，19例拒绝手术并死亡。多因素分析确定了以下决定MMCA卒中是否进行DHC的因素：年龄<55岁（比值比[OR]8.5，95%置信区间[CI]3.3 - 22.1，P<0.001），大脑中动脉累及其他血管区域（大脑前动脉、大脑后动脉，OR 4.8，95%CI 1.5 - 14.9，P = 0.007），透明隔移位≥7.5 mm（OR 4.8，95%CI 1.9 - 11.7，P = 0.001），糖尿病（OR 3.7，95%CI 1.3 - 10.6，P = 0.012），梗死生长速率（IGR）ml/h（OR 1.11，95%CI 1.02 - 1.2，P = 0.015），以及颞叶受累（OR 2.5，95%CI 1.01 - 6.1，P = 0.048）。使用自抽样分析对多因素逻辑回归模型进行内部验证显示存在轻微偏差。在MMCA梗死患者中，进行DHC可能性增加与年龄较小、大脑中动脉合并其他梗死、透明隔移位>7.5 mm、糖尿病、IGR以及颞叶受累有关。这些危险因素提示那些可能需要进行DHC的MMCA卒中患者。自抽样分析表明该模型足以预测一般人群的结局。
