Affiliation:
1. Department of Neurological Surgery University of Tennessee Health Science Center Memphis TN
2. Semmes Murphey Clinic Memphis TN
3. Department of Neurology University of Tennessee Health Science Center Memphis TN
4. Second Department of Neurology “Attikon University Hospital,” National & Kapodistrian University of Medicine School of Medicine University of Athens Athens Greece
Abstract
Background
Mechanical thrombectomy (MT) has been shown to improve functional outcome in patients with anterior circulation strokes and emergent large‐vessel occlusion (ELVO). Despite successful recanalization, some of these patients require decompressive hemicraniectomy (DHC). We aimed to study the predictors of DHC in successfully recanalized anterior circulation ELVO patients.
Methods
Consecutive patients with anterior circulation ELVO treated with MT during a 6‐year period were evaluated. Only successfully recanalized patients (modified Thrombolysis in Cerebral Infarction grades 2b, 2c, or 3) after MT were included in the analysis. Baseline demographic, clinical, and procedural variables were compared between patients requiring DHC after successful recanalization versus those who did not.
Results
Of 453 successfully recanalized patients with ELVO, 47 who underwent DHC had higher admission blood glucose levels (170±88 versus 142±66 mg/dL;
P
=0.008), lower median Alberta Stroke Program Early CT Scores (9 [interquartile range, 8–10] versus 10 [interquartile range, 9–10];
P
=0.002), higher prevalence of poor collaterals on pretreatment computed tomography angiogram (75% versus 26%;
P
<0.001), and required more passes during MT (median, 3 [interquartile range, 3–4] versus 2 [interquartile range, 1–2];
P
=0.001) compared with those who did not undergo DHC. In a multivariable model after adjusting for multiple confounders, higher admission blood glucose levels (
P
=0.031), poor collaterals on computed tomography angiography (
P
<0.001), and higher number of passes during MT (
P
<0.001) emerged as independent predictors of DHC in successfully recanalized patients with ELVO.
Conclusions
Higher admission blood glucose levels, poor collateral pattern on computed tomography angiography, and higher number of passes during MT were independently associated with DHC in patients with anterior circulation ELVO achieving successful recanalization following MT.
Publisher
Ovid Technologies (Wolters Kluwer Health)