Early Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction: A single centre retrospective study (P4.290)

Objective: To evaluate the role of early decompressive hemicraniectomy in Asian patients with a massive acute Ischemic Stroke(IS). Background: Decompression craniectomy in acute malignant middle cerebral artery (MCA) ischemic stroke (IS) reduces mortality. However, its role in reducing disability in this group of patients is often questioned in the stroke community since previous studies have employed variable time intervals for surgical decompression as well as criteria for defining severe disability. Design/Methods: Data for all acute IS patients hospitalized were entered into a prospectively maintained registry. In this retrospective analysis, data for all malignant MCA IS patients who underwent decompressive hemicraniectomy were extracted. Various demographic, clinical and neuroimaging factors were analyzed for identifying independent predictors of favorable functional outcome at 6 months, which was defined as modified Rankin Scale of 0–3. Results: From January 2005 to December 2014, a total of 75 patients with anterior circulation IS underwent decompressive hemicraniectomy. Median age was 55 years [Inter Quartile Range(IQR) 44–64] with male preponderance (66%) and median National Institute of Health Stroke Scale (NIHSS) score 21 points (IQR 18–24). Considerable proportion of them (60%) received intravenous thrombolysis with tissue plasminogen activator (IV-tPA). Majority (70%) of patients suffered from acute right MCA IS and median time from symptom-onset to surgery was 31 hours (range18–51). Decompressive surgery was performed within 48 hours of symptom-onset in 50 (67%) of the patients. Favorable functional outcome was achieved by 25 (33.3%) patients at 6 months. Right sided stroke (OR= 9.158; 95% CI 1.881– 44.596, p=0.006) and early decompression surgery (performed within 48 hours from symptom-onset (OR = 4.011; 95% CI = 1.058– 15.208, p=0.041) were independent predictors of favorable functional outcome at 6 months. Conclusions: Early decompression craniectomy, especially in right MCA ischemic stroke is associated with better favorable functional outcome at 6 months. Disclosure: Dr. Bharatendu has nothing to disclose. Dr. Chong has nothing to disclose. Dr. Paliwal has nothing to disclose. Dr. Teoh has nothing to disclose. Dr. Yeo has nothing to disclose. Dr. Seet has nothing to disclose. Dr. Chan has nothing to disclose. Dr. YEO has nothing to disclose. Dr. LWIN has nothing to disclose. Dr. NING has nothing to disclose. Dr. SHARMA has nothing to disclose.