OBJECTIVE Revascularization by pharmacological and/or endovascular treatment is an effective therapy for acute ischemic stroke caused by artery occlusion. In the context of malignant middle cerebral artery infarction (MMI), decompressive hemicraniectomy (DHC) can be life-saving. However, its effectiveness and safety after revascularization have not been thoroughly assessed. This retrospective study aimed to determine the risk profile of pre-surgical revascularization treatment (RT) for subsequent DHC. METHODS A total of 152 consecutive patients treated by DHC after MMI were identified between 2012 and 2015. After elimination of cases with previous stroke and cases pre-treated with antiplatelets or anticoagulants (increased postoperative bleeding), twenty-four out of fifty patients (n = 24/50, 48%) received pre-surgical revascularization treatment by intravenous thrombolysis (TL), mechanical thrombectomy (MT) or a combination of both. Demographic data was compared alongside perioperative, postoperative complications (intra-/extracerebral hemorrhage, revision surgery due to hemorrhage or infection, and overall mortality) and economic parameters. RESULTS Comparing patients with and without prior RT, there was no statistically significant difference in duration of surgery (RT: 83 [57-116] min vs. no-RT: 96 [69-119] min, p = 0.308), intraoperative blood loss (RT: 300 [225-375] ml vs. no-RT: 300 [250-400] ml, p = 0.763), intraoperative transfusion requirement (RT: 12.5% vs. no-RT: 26.9%, p = 0.294), or need for volume substitution (RT: 1300 [1200-1400] ml vs. no-RT: 1200 [1100-1400] ml, p = 0.359). The rate of postoperative complications was also comparable in both groups, including intra-/extracerebral hemorrhage, revision due to hemorrhage or infections, and mortality (p = 0.814, p = 0.520, p = 0.697, and p = 0.769). Health economic parameters were not affected (ventilation time: RT: 309 [12-527] hrs. vs. no-RT: 444 [171-605] hrs., p = 0.120, length of stay: RT: 23 [13-32] days vs. no-RT: 28 [19-41], p = 0.156, and stay costs: RT: 27768 [13044-60,248] € vs. no-RT: 35422 [21225-49,585] €, p = 0.312). CONCLUSION DHC for patients with MMI who previously received revascularization therapy appears to be safe and not associated with a higher complication rate or increased health economic burden.

中文翻译：

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血运重建治疗后恶性脑卒中去骨瓣减压术的风险概况

目的通过药物和/或血管内治疗进行血运重建是动脉闭塞引起的急性缺血性卒中的有效治疗方法。在恶性大脑中动脉梗死 (MMI) 的背景下，减压偏侧颅骨切除术 (DHC) 可以挽救生命。然而，其在血运重建后的有效性和安全性尚未得到彻底评估。这项回顾性研究旨在确定术后 DHC 术前血运重建治疗 (RT) 的风险概况。方法 在 2012 年至 2015 年间，共确定了 152 名 MMI 后接受 DHC 治疗的连续患者。在消除既往卒中病例和预先接受抗血小板或抗凝剂治疗（术后出血增加）的病例后，50 名患者中有 24 名（n = 24/50, 48%) 通过静脉溶栓 (TL)、机械取栓 (MT) 或两者的组合接受了术前血运重建治疗。将人口统计学数据与围手术期、术后并发症（脑内/脑外出血、因出血或感染引起的翻修手术以及总体死亡率）和经济参数进行比较。结果 比较既往接受过放疗和未接受过放疗的患者，手术持续时间（放疗：83 [57-116] 分钟 vs. 未放疗：96 [69-119] 分钟，p = 0.308）、术中血液损失（RT：300 [225-375] ml vs. no-RT：300 [250-400] ml，p = 0.763），术中输血需求（RT：12.5% vs. no-RT：26.9%，p = 0.294 )，或需要容量替代（RT：1300 [1200-1400] ml 与无 RT：1200 [1100-1400] ml，p = 0.359）。两组的术后并发症发生率也相当，包括脑内/外出血、因出血或感染导致的翻修和死亡率（p = 0.814、p = 0.520、p = 0.697 和 p = 0.769）。健康经济参数未受影响（通气时间：RT：309 [12-527] 小时 vs. 无 RT：444 [171-605] 小时，p = 0.120，住院时间：RT：23 [13-32] ] 天与无 RT：28 [19-41]，p = 0.156，住宿费用：RT：27768 [13044-60,248] € 与无 RT：35422 [21225-49,585] €，p = 0.312） . 结论 对于先前接受过血运重建治疗的 MMI 患者，DHC 似乎是安全的，并且与更高的并发症发生率或增加的健康经济负担无关。520，p = 0.697 和 p = 0.769）。健康经济参数未受影响（通气时间：RT：309 [12-527] 小时 vs. 无 RT：444 [171-605] 小时，p = 0.120，住院时间：RT：23 [13-32] ] 天与无 RT：28 [19-41]，p = 0.156，住宿费用：RT：27768 [13044-60,248] € 与无 RT：35422 [21225-49,585] €，p = 0.312） . 结论 对于先前接受过血运重建治疗的 MMI 患者，DHC 似乎是安全的，并且与更高的并发症发生率或增加的健康经济负担无关。520，p = 0.697 和 p = 0.769）。健康经济参数未受影响（通气时间：RT：309 [12-527] 小时 vs. 无 RT：444 [171-605] 小时，p = 0.120，住院时间：RT：23 [13-32] ] 天与无 RT：28 [19-41]，p = 0.156，住宿费用：RT：27768 [13044-60,248] € 与无 RT：35422 [21225-49,585] €，p = 0.312） . 结论 对于先前接受过血运重建治疗的 MMI 患者，DHC 似乎是安全的，并且与更高的并发症发生率或增加的健康经济负担无关。