Abstract WP283: Medical Treatment Matters: Using Headdfirst Results To Enhance The Lessons From The European Hemicraniectomy Trials For Stroke
Introduction: HeADDFIRST was a randomized trial to evaluate the benefit of surgical decompression for brain swelling from large supratentorial cerebral hemispheric infarction (LSCHI). Subsequently, several similar European trials have been completed. Several unique aspects about HeADDFIRST findings provide specific lessons about patient selection and the significance of medical management to outcome, particularly in the context of these trials.
Methods: All patients were screened for eligibility (age 18-75, NIHSS > 18, and CT demonstrating at least compete MCA territory infarction by specific imaging criteria). Those without exclusions and consented were treated by a standardized medical treatment protocol. Those with > 4 mm of pineal shift or > 7.5 mm of anteroseptal shift within 96 hours of stroke onset were randomized to the medical treatment only (MTO) or surgical + medical treatment (SMT) arms with struct adherence.
Results: 40 patients were registered, and 26 developed the requisite brain swelling for randomization. All of those consented who failed to develop the degree of brain swelling required for randomization survived. The 180-day mortality was 40% and 35.7% in the MTO and SMT arms, respectively. From the pooled meta-analysis of the European trials’ the 12-month mortality was 71% and 22% in the medical and surgical arms.
Conclusion: 1. HeADDFIRST medical treatment outcomes were profoundly better than the European trials, suggesting some significance to our medical treatment protocol differences and the strict adherence.
2. HeADDFIRST randomization criteria accurately differentiates between survivors vs. those with a high risk of non-survival with LSCHI.
- © 2012 by American Heart Association, Inc.