DESTINY - DEcompressive Surgery for the Treatment of Malignant INfarction of the Middel Cerebral ArterY

Jüttler, Eric; Schwab, S.; Schmiedek, Peter; Mansmann, U.; Hacke, Werner

doi:10.1055/s-2005-919707

Cited by 10 publications

(19 citation statements)

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“…Six trials included patients who were previously independent (modified Rankin's score [mRS] ≤1), with severe stroke (NIHSS ≥ 15) and reduced consciousness. 64 Four trials included patients with infarction involving two-thirds or more of the MCA territory 61 63 64 65 and the other four trials included an infarct of more than 50% of the MCA territory. 62 64 66 67 In HeADDFIRST, the protocol required participants to have midline shift.…”

Section: Summary Of Evidence For Decompressive Hemicraniectomy For Ma...mentioning

confidence: 99%

Surgery for Malignant Acute Ischemic Stroke: A Narrative Review of the Knowns and Unknowns

Krishnan,

Hollingworth,

Nguyen

et al. 2023

Semin Neurol

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Malignant acute ischemic stroke (AIS) is characterized by acute neurological deterioration caused by progressive space-occupying brain edema, often occurring in the first hours to days after symptom onset. Without any treatment, the result is often fatal. Despite advances in treatment for AIS, up to 80% of patients with a large hemispheric stroke or cerebellar stroke are at risk of poor outcome. Decompressive surgery can be life-saving in a subgroup of patients with malignant AIS, but uncertainties exist on patient selection, predictors of malignant infarction, perioperative management, and timing of intervention. Although survivors are left disabled, most agree with the original decision to undergo surgery and would make the same decision again. In this narrative review, we focus on the clinical and radiological predictors of malignant infarction in AIS and outline the technical aspects of decompressive surgery as well as duraplasty and cranioplasty. We discuss the current evidence and recommendations for surgery in AIS, highlighting gaps in knowledge, and suggest directions for future studies. Key Points

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Section: Summary Of Evidence For Decompressive Hemicraniectomy For Ma...mentioning

confidence: 99%

Surgery for Malignant Acute Ischemic Stroke: A Narrative Review of the Knowns and Unknowns

Krishnan,

Hollingworth,

Nguyen

et al. 2023

Semin Neurol

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“…Global measures of disability, such as the modified Rankin score, can be informative and are widely used in other neurologic contexts, such as stroke 18 and encephalitis, 19 but are useful only if measured using formalized definitions and preferably prospectively. A consensus NS-specific metric that measures change and severity within the affected neuroanatomy of a patient could provide a meaningful way forward.…”

Section: Challenges In Repurposing Disability Metrics From Other Dise...mentioning

confidence: 99%

Demystifying Neurosarcoidosis and Informing Prognosis

Gelfand

2017

JAMA Neurol

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“…The analysis of 3 published randomized studies (DECIMAL, 13 DESTINY 14 AND HAMLET 15 ) showed that the survival rate of the group subjected to decompressive surgery (78%) more than doubled compared with that of the group treated conservatively (29%). 16 17 This staggering absolute risk reduction of 49% was highly significant.…”

Section: Introductionmentioning

confidence: 99%

Predictive Mortality Factors after Decompressive Craniectomy in Ischemic Stroke

Leite

Barbosa

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Background Decompressive craniectomy is a consolidated method for the treatment of malignant ischemic stroke (iS) in the territory of the middle cerebral artery. Thus, factors contributing to mortality constitute an important area of investigation. Objective To evaluate the epidemiological clinical profile and predictors of mortality in a single-center population of patients undergoing decompressive craniectomy for the treatment of malignant iS. Methods A single-center retrospective study was performed in 87 patients with malignant iS subjected to emergency decompressive craniectomy from January 2014 to December 2017. Age, gender, laterality, aphasia, time interval between disease onset and treatment, and clinical and neurological outcomes using the Glasgow coma scale were assessed. The patients were stratified by age: a group of participants 60 years old or younger, and a group of participants older than 60 years old for assessment of survival and mortality by the Kaplan-Meier test and log-rank comparison. The intensity of the association between demographic and clinical variables was evaluated by multivariate Cox regression. Results Ischemic stroke was prevalent in patients with hypertension (63.29%). Seventy-seven (84%) patients had some type of postoperative complication, mostly pneumonia (42.8%). The risk of death was 2.71 (p = 0.0041) and 1.93 (p = 0.0411) times higher in patients older than 60 and with less than 8 points on the Glasgow coma scale, respectively. Conclusion Malignant iS has a significant mortality rate. Age above 60 years and Glasgow coma scale values below 8 were statistically correlated with unfavorable prognosis.

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DESTINY - DEcompressive Surgery for the Treatment of Malignant INfarction of the Middel Cerebral ArterY

Cited by 10 publications

References 0 publications

Surgery for Malignant Acute Ischemic Stroke: A Narrative Review of the Knowns and Unknowns

Surgery for Malignant Acute Ischemic Stroke: A Narrative Review of the Knowns and Unknowns

Demystifying Neurosarcoidosis and Informing Prognosis

Predictive Mortality Factors after Decompressive Craniectomy in Ischemic Stroke

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