Ramponi Alberto, Di Cristofori Andrea, Graziano Francesca, Fiori Leonardo, Remida Paolo, Patassini Mirko, Galbiati Andrea, Beretta Simone, Galimberti Stefania, Carrabba Giorgio, Giussani Carlo
Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, Monza, 20900, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Milan, Italy.
Neurol Sci. 2025 Sep 16. doi: 10.1007/s10072-025-08476-1.
Treatment of acute ischemic stroke (AIS) management is early revascularization. Mechanical thrombectomy (MT) has emerged as a powerful treatment option for LVO. Although MT, some patients develop malignant brain edema with intracranial hypertension. Decompressive craniectomy (DC) has proven effective in managing intracranial hypertension and preventing early mortality when performed within 48 h of stroke onset.
Our study aims to investigate whether previous MT influences specific procedural aspects of DC. Additionally, we looked for potential radiological indicators that could be used in clinical practice to predict the need for DC following MT.
Our retrospective study included patients that underwent DC for malignant anterior circulation AIS between January 2008 and December 2023 at Fondazione IRCCS San Gerardo dei Tintori. Only patients with anterior circulation large vessel AIS of thrombotic or embolic origin were included. Patients who underwent MT prior to DC were included in a first group (MT patients); while patients who did not underwent MT constituted the control group (non-MT patients).
DC in MT patients was required after an average of 29.28 h from symptom onset, compared to 49.77 h in the control group (p < 0.005). Intraparenchymal hyperdensity was present at 12 h in 66.7% of cases in the first group and in 11.5% in the second group (p < 0.001). Midline shift was observed at 36 h in 18 MT patients in contrast to 12 patients in non-MT group (p = 0.012).
Patients undergoing MT for anterior circulation LVO may still require DC, even after achieving successful reperfusion. In this subgroup, a more rapid progression to malignant stroke has been observed.
急性缺血性卒中（AIS）的治疗关键在于早期血管再通。机械取栓术（MT）已成为治疗大血管闭塞（LVO）的有效方法。尽管有MT治疗，但部分患者仍会出现伴有颅内高压的恶性脑水肿。减压性颅骨切除术（DC）已被证明在卒中发作48小时内进行时，对控制颅内高压和预防早期死亡有效。
我们的研究旨在探讨既往MT是否会影响DC的具体手术操作环节。此外，我们寻找了可在临床实践中用于预测MT后是否需要DC的潜在影像学指标。
我们的回顾性研究纳入了2008年1月至2023年12月在圣杰拉尔多·德伊·廷托里基金会接受DC治疗的恶性前循环AIS患者。仅纳入血栓形成或栓塞性起源的前循环大血管AIS患者。在DC前接受MT的患者纳入第一组（MT患者）；未接受MT的患者构成对照组（非MT患者）。
MT患者从症状发作到需要DC的平均时间为29.28小时，而对照组为49.77小时（p < 0.005）。第一组66.7%的病例在12小时出现脑实质内高密度影，第二组为11.5%（p < 0.001）。36小时时，18例MT患者出现中线移位，而非MT组为12例（p = 0.012）。
接受MT治疗前循环LVO的患者，即使成功再灌注后仍可能需要DC。在这一亚组中，已观察到向恶性卒中的进展更为迅速。
