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Recent Nationwide Impact of Mechanical Thrombectomy on Decompressive Hemicraniectomy for Acute Ischemic Stroke

Stroke (1970), 2019-08, Vol.50 (8), p.2133-2139 [Peer Reviewed Journal]

2019 American Heart Association, Inc. ;ISSN: 0039-2499 ;EISSN: 1524-4628 ;DOI: 10.1161/STROKEAHA.119.025063 ;PMID: 31208301

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  • Title:
    Recent Nationwide Impact of Mechanical Thrombectomy on Decompressive Hemicraniectomy for Acute Ischemic Stroke
  • Author: Rumalla, Kavelin ; Ottenhausen, Malte ; Kan, Peter ; Burkhardt, Jan-Karl
  • Subjects: Aged ; Aged, 80 and over ; Brain Edema - etiology ; Brain Edema - surgery ; Decompressive Craniectomy - mortality ; Decompressive Craniectomy - statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Stroke - complications ; Stroke - mortality ; Stroke - surgery ; Thrombectomy - methods ; Thrombectomy - mortality
  • Is Part Of: Stroke (1970), 2019-08, Vol.50 (8), p.2133-2139
  • Description: BACKGROUND AND PURPOSE—The treatment of patients with acute ischemic stroke has been revolutionized by endovascular mechanical thrombectomy (MT), leading to dramatically improved outcomes. Here, we analyzed the impact of recent changes in stroke management on nationwide trends in patient characteristics, treatment modalities, and outcomes. METHODS—The National Inpatient Sample was analyzed using International Classification of Diseases, Ninth and Tenth Editions, Clinical Modification codes to identify adult stroke patients with anterior-circulation, large-vessel occlusion in the pre- (2012–2014) and the post-MT trial period (2015–2016). Univariate and multivariable predictors of decompressive hemicraniectomy (DHC) were ascertained in patients developing malignant cerebral edema. RESULTS—The nationwide query identified 519 320 adult stroke patients with annually increasing volume (92 320 to 129 340), stroke severity, and treatment at urban teaching centers. DHC was performed in 9.5% of patients developing malignant cerebral edema (n=33 530) and was associated with a high rate of discharge to long-term nursing care (65%) and mortality (23%). Over time, the rate of MT (3.4% to 9.8%) increased whereas the rate of DHC for malignant cerebral edema declined from 11.4% to 4.8% (P<0.001). In a binary logistic regression model controlling for potential confounders (eg, age, severity of illness), MT patients were 43% less likely to require DHC (odds ratio, 0.7; 95% CI, 0.6–0.9). CONCLUSIONS—Nationwide trends indicated that successful reperfusion of penumbra with MT in stroke patients leads to a declining indication for DHC whereas stroke volume increases over time.
  • Publisher: United States: American Heart Association, Inc
  • Language: English
  • Identifier: ISSN: 0039-2499
    EISSN: 1524-4628
    DOI: 10.1161/STROKEAHA.119.025063
    PMID: 31208301
  • Source: MEDLINE
    Alma/SFX Local Collection
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