Malignant internal carotid artery (ICA) infarction is an entirely different disease entity when compared with middle cerebral artery (MCA) infarction. Because of an increased area of infarction, it is assumed to have a poorer prognosis; however, this has never been adequately investigated. Decompressive craniectomy (DC) for malignant MCA infarction has been shown to improve mortality rates in several randomized controlled trials. Conversely, aggressive surgical decompression for ICA infarction has not been recommended. The authors sought to compare the functional outcomes and survival between patients with ICA infarctions and those with MCA infarctions after DC in the largest series to date to investigate this assumption.

A multicenter retrospective review of 154 consecutive DCs for large territory cerebral infarctions performed from 2005 to 2020 were analyzed. Patients were divided into ICA and MCA groups depending on the territory of infarction. Variables, including age, sex, medical comorbidities, laterality of the infarction, preoperative neurological status, primary stroke treatment, and the time from stroke onset to DC, were recorded. Univariable and multivariable analyses were performed for the clinical exposures for functional outcomes (modified Rankin Scale [mRS] score) on discharge and at the 1- and 6-month follow-ups, and for mortality, both inpatient and at the 1-year follow-up. A favorable mRS score was defined as 0–2.

There were 67 patients (43.5%) and 87 patients (56.5%) in the ICA and MCA groups, respectively. Univariable analysis showed that the ICA group had a comparably favorable mRS (OR 0.15 [95% CI 0.18–1.21], p = 0.077). Inpatient mortality (OR 1.79 [95% CI 0.79–4.03], p = 0.16) and 1-year mortality (OR 2.07 [95% CI 0.98–4.37], p = 0.054) were comparable between the groups. After adjustment, a favorable mRS score at 6 months (OR 0.17 [95% CI 0.018–1.59], p = 0.12), inpatient mortality (OR 1.02 [95% CI 0.29–3.57], p = 0.97), and 1-year mortality (OR 0.94 [95% CI 0.41–2.69], p = 0.88) were similar in both groups. The overall survival, plotted using the Cox proportional hazard regression, did not show a significant difference between the ICA and MCA groups (HR 0.581).

Unlike previous smaller studies, this study found that patients with malignant ICA infarction had a functional outcome and survival that was similar to those with MCA infarction after DC. Therefore, DC can be offered for malignant ICA infarction for life-saving purposes with limited functional recovery.

与大脑中动脉 (MCA) 梗死相比，恶性颈内动脉 (ICA) 梗死是一种完全不同的疾病实体。由于梗死面积增加，推测预后较差；然而，这从未得到充分调查。几项随机对照试验表明，用于恶性 MCA 梗死的去骨瓣减压术 (DC) 已被证明可以提高死亡率。相反，不建议对 ICA 梗塞进行积极的手术减压。作者试图在迄今为止最大的系列研究中比较 ICA 梗死患者和 DC 后 MCA 梗死患者的功能结果和存活率，以研究这一假设。

对 2005 年至 2020 年对大面积脑梗死的 154 例连续 DC 进行的多中心回顾性研究进行了分析。根据梗塞的范围，将患者分为 ICA 和 MCA 组。记录变量，包括年龄、性别、合并症、梗死的偏侧性、术前神经系统状态、主要卒中治疗以及从卒中发病到 DC 的时间。对出院时和 1 个月和 6 个月随访时的功能结果（改良 Rankin 量表 [mRS] 评分）的临床暴露以及住院和 1 年随访时的死亡率进行单变量和多变量分析-向上。有利的 mRS 评分定义为 0-2。

ICA 和 MCA 组分别有 67 名患者（43.5%）和 87 名患者（56.5%）。单变量分析显示 ICA 组的 mRS 相对较好（OR 0.15 [95% CI 0.18–1.21]，p = 0.077）。两组之间的住院死亡率（OR 1.79 [95% CI 0.79-4.03]，p = 0.16）和1年死亡率（OR 2.07 [95% CI 0.98-4.37]，p = 0.054）具有可比性。调整后，6 个月（OR 0.17 [95% CI 0.018-1.59]，p = 0.12）、住院死亡率（OR 1.02 [95% CI 0.29-3.57]，p = 0.97）和 1 年时 mRS 评分良好两组的死亡率（OR 0.94 [95% CI 0.41–2.69]，p = 0.88）相似。使用 Cox 比例风险回归绘制的总生存期未显示 ICA 和 MCA 组之间的显着差异（HR 0.581）。

与之前的小型研究不同，本研究发现恶性 ICA 梗死患者的功能结果和生存率与 DC 后 MCA 梗死患者相似。因此，DC 可用于恶性 ICA 梗死，以挽救生命，但功能恢复有限。