Abstract W P133: Combined Malignant MCA Plus ACA or PCA Infarcts Do Not Have a Worse Outcome Than Isolated Malignant MCA Infarcts in Patients One Year Following Decompressive Hemicraniectomy
Background: Malignant MCA infarction is a devastating disease associated with up to 80% mortality due to edema and herniation. Evidence from three European randomized trials show that decompressive hemicraniectomy (DHC) may improve functional outcomes in select patients. Adjacent cerebral territorial infarction often coincides with malignant MCA infarcts. This study compares the effects of isolated malignant MCA infarcts versus combined malignant MCA plus ipsilateral (ACA or PCA) infarcts on functional outcomes in patients surviving one or more years following DHC. We hypothesized that patients with no additional territorial involvement would have a better functional outcome.
Methods: Retrospective analysis was performed on patients who underwent DHC for malignant MCA infarction from 03/2006 to 03/2012. Inclusion criteria include: Age 18-60, clinical and radiographical diagnosis of acute unilateral MCA stroke involving at least 50% of MCA territory, and DHC performed primarily to treat space occupying edema . Exclusion criteria include: Prestroke mRs of >2, life expectancy < 3 years, and death < 1 year after DHC. Patients were divided into two groups: (a) those with isolated MCA infarcts and (b) those with MCA combined with significant adjacent ipsilateral ACA or PCA involvement. Functional outcomes were calculated using the modified Rankin scale (mRs). The mean mRs was calculated for each group and the Wilcoxon-Mann-Whitney two tailed test was used to calculate statistical significance. Alpha level was set at p< 0.05.
Results: A total of 26 patients met criteria. 20 patients had isolated MCA infarcts while 6 had combined MCA plus ACA or PCA infarcts. No statistical difference in functional outcome was observed between the isolated MCA group (x- =3.6) and the combined MCA group (x- =3.83) (p value=0.614).
Conclusion: In this retrospective study, patients surviving one year after their DHC did not demonstrate a worse functional outcome due to additional cerebral territorial co-infarction. These findings argue against a major negative influence of combined infarctions on functional outcome compared to previous limited studies. Larger studies are needed to verify these results and to better assess criteria for ideal patient selection for DHC.
Author Disclosures: L. Maali: None. K. Abdelerahaman: None.
- © 2015 by American Heart Association, Inc.