Unexpected Arterial Recanalization after Decompressive Hemicraniectomy

Vassileva, Evguenia; Stoyanov, Petar; Vavrek, Evgenii; Stamenova, P.

doi:10.1016/j.jstrokecerebrovasdis.2013.05.023

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…Another possible explanation is similar to the above; except the recanalisation was not spontaneous but rather due to the decompression surgery. This phenomenon has been reported before [13]. A 43-year-old patient with "malignant" edema after embolic occlusion of the right MCA underwent DC.…”

Section: Discussionmentioning

confidence: 63%

Asymmetric TCD Findings in Malignant MCA Infarction, Resolution after Decompressive Hemicraniectomy: A Case Report

et al. 2020

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Transcranial Doppler (TCD) is a non-invasive method for assessing cerebral hemodynamics in the acute phase of stroke. We report a case of a 33-year-old man who presented with a massive left hemispheric infarct developing into “malignant” MCA infarction. TCD was utilized to monitor intracranial hemodynamics while the clinical and neuroimaging findings were used to help us in the decision to proceed with decompressive craniectomy (DC). Pre-operatively, there was reduced mean flow velocities (MFV) of the middle cerebral artery (MCA) with increasing pulsatility index (PI) ipsilateral to the infarct. The subsequent but smaller rise in the PI in the contralateral MCA was suggestive of very high intracranial pressure (ICP) from massive brain swelling. Serial TCD examinations post-operatively showed normalization of the PI, and subsequent rise in the left MCA MFV. Clinical improvement was also noted as the TCD findings improved. The asymmetry in TCD findings can be attributed to occlusion of the MCA with subsequent spontaneous recanalisation, occlusion of the MCA with subsequent recanalisation due to the DC, or initial occlusion and subsequent pressure effects on the arterioles of the MCA due to the “malignant” edema of that hemisphere that was relieved by DC. This case illustrates the value of TCD as a useful modality in monitoring intracranial hemodynamics in acute stroke.

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Section: Discussionmentioning

confidence: 63%

Asymmetric TCD Findings in Malignant MCA Infarction, Resolution after Decompressive Hemicraniectomy: A Case Report

et al. 2020

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“…It is usually secondary to the acute occlusion of the proximal MCA trunk or the distal ICA. 18 Pathophysiologically, early damage to cerebrovascular autoregulation in the tissues surrounding the infarction, increased vascular permeability, and the loss of the integrity of the endothelial basal layer altogether play important roles in the progression of MCE. 19 , 20 The early detection of MCE and the use of decompressive surgery can improve the clinical outcomes of patients with MCE.…”

Section: Discussionmentioning

confidence: 99%

Radiomics analysis for predicting malignant cerebral edema in patients undergoing endovascular treatment for acute ischemic stroke

Wen¹,

Hu²,

Xiao³

et al. 2023

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T he safety and efficacy of endovascular treatment (EVT) for anterior circulation large vessel occlusive stroke (LVOS) have been verified in randomized controlled trials. However, nearly 45% of the cases with LVOS cannot recover after EVT. 1,2 Recent evidence has revealed that malignant cerebral edema (MCE) commonly occurs after EVT, and the development of MCE may reduce the benefit-risk ratio of EVT. [3][4][5] MCE is a severe complication of stroke that occurs in approximately 10% of all patients with stroke. The prognosis for MCE is poor, with a mortality rate of 80% when treated conservatively. 6 Early decompressive surgery effectively lowers mortality and improves the clinical outcomes of patients with MCE. 7 The addition of decompressive craniectomy to the best medical therapy can reduce the mortality rate of MCE by 50%-75%. 8 Hence, the early identification of patients at a high risk of MCE is critical for therapeutic decision-making. The imaging predictors for MCE that have been studied so far primarily involve the characterization of the infarction size, neurovascular condition, and brain perfusion of the patient. 7 PURPOSERadiomics analysis is a promising image analysis technique. This study aims to extract a radiomics signature from baseline computed tomography (CT) to predict malignant cerebral edema (MCE) in patients with acute anterior circulation infarction after endovascular treatment (EVT). METHODSIn this retrospective study, 111 patients underwent EVT for acute ischemic stroke caused by middle cerebral artery (MCA) and/or internal carotid artery occlusion. The participants were randomly divided into two datasets: the training set (n = 77) and the test set (n = 34). The clinico-radiological profiles of all patients were collected, including cranial non-contrast-enhanced CT, CT angiography, and CT perfusion. The MCA territory on non-contrast-enhanced CT images was segmented, and the radiomics features associated with MCE were analyzed. The clinico-radiological parameters related to MCE were also identified. In addition, a routine visual radiological model based on radiological factors and a combined model comprising radiomics features and clinico-radiological factors were constructed to predict MCE. RESULTSThe areas under the curve (AUCs) of the radiomics signature for predicting MCE were 0.870 (P < 0.001) and 0.837 (P = 0.002) in the training and test sets, respectively. The AUCs of the routine visual radiological model were 0.808 (P < 0.001) and 0.813 (P = 0.005) in the training and test sets, respectively. The AUCs of the model combining the radiomics signature and clinico-radiological factors were 0.924 (P < 0.001) and 0.879 (P = 0.001) in the training and test sets, respectively. CONCLUSIONA CT image-based radiomics signature is a promising tool for predicting MCE in patients with acute anterior circulation infarction after EVT. For clinicians, it may assist in diagnostic decision-making.

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Unexpected Arterial Recanalization after Decompressive Hemicraniectomy

Cited by 2 publications

References 17 publications

Asymmetric TCD Findings in Malignant MCA Infarction, Resolution after Decompressive Hemicraniectomy: A Case Report

Asymmetric TCD Findings in Malignant MCA Infarction, Resolution after Decompressive Hemicraniectomy: A Case Report

Radiomics analysis for predicting malignant cerebral edema in patients undergoing endovascular treatment for acute ischemic stroke

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