Proper Indication of Decompressiv Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy.

Introduction: Many studies have reported that early decompressive craniectomy (DC) for patients with major infarction, could be a life-saving and improve neurological outcomes. However, most of these studies were reported by neurologist before additional intra-arterial thrombectomy (IA-Tx) became popular. The purpose of this study is weather neurologic status is significant for the final clinical outcome of the patient who underwent DC after IA-Tx in major infarction .

Methods: Sixty-seven patients with major anterior circulation major infarction who underwent DC after IA-Tx with or without intravenous tissue plasminogen activator (IV-tPA), were included in this analysis. We retrospectively reviewed the medical records, radiological findings and compare the neurologic outcomes according to the “surgical time window” and neurological status at the time of surgery.

Results: For patients treated with DC after IA-Tx, a Glasgow Coma Scale (GCS) score of 7 was the lowest score associated with a favorable outcome (p = 0.013). Favorable outcomes correlated significantly with successful recanalization after IA-Tx (p = 0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p = 0.007). However, the surgical time window (within 36 h, p = 0.389; within 48 h, p = 0.283) did not correlate with neurological outcomes.

Conclusion : From this study, indication for DC after IA-Tx, should include neurological status (GCS  7) because in some patients being treated early DC without considering the neurologic status may be underwent an unnecessary surgery