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Stroke Research and Treatment
Volume 2017, Article ID 2507834, 8 pages
Research Article

Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate

1Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
2Weill Cornell School of Medicine, Doha, Qatar
3Rashid Hospital, Dubai, UAE
4College of Liberal Arts and Sciences, University of Illinois at Chicago, Chicago, IL, USA
5Shifa International Hospital, Islamabad, Pakistan
6Stroke Program, University of Alberta, Edmonton, AB, Canada

Correspondence should be addressed to Saadat Kamran; moc.liamtoh@dmnarmaks

Received 26 December 2016; Accepted 22 February 2017; Published 16 March 2017

Academic Editor: David Vaudry

Copyright © 2017 Saadat Kamran et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective and Methods. The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months. Results. In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [] and mortality []. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [] in patients with early surgery [under 48 hours]. Conclusions. The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery.