Abstract TP135: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: Role of Infarct Growth

Objective: The purpose of this multi-institutional pooled data analyses from three countries was to determine the impact of DHC timing on the functional outcomes in patients operated beyond 48 hours in comparison with DHC under 48 hours. In addition factors leading to early or late DHC were also identified. Methods: Retrospective, multicenter cross-sectional study to measure outcome following DHC <48 or >48 hours using the modified Rankin Scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4, at three months. Results: In total 137 patients underwent DHC. There was no significant difference in the functional outcome [P=0.140] and mortality [P=0.975] but with a trend towards better outcome in patients operated over 48 hours. Multivariate analysis showed age ≥ 55, MCA with additional infarction, septum pellucidum deviation ≥1cm, and uncal herniation was independent predictor of poor functional outcome at three months. In the ‘‘best’’ multivariate model IGR >7.5ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] [DHC<48 hours, 15.2± 8.1ml/hr vs. >48 hours, 7.1 ± 5.03ml/hr] [P<0.001] and second infarct growth rate [IGR2] [DHC 48 13.64 ±8.76 ml/hr, > 48 hours 7.15 ±6.23 ml/hr [P<0.001] were nearly double in patients with early surgery [<48 hours]. Conclusions: There was no significant difference in the functional outcome and mortality in patients operated >48 hours of stroke onset compared to early [<48 hours]. Time to surgery had no impact on functional outcome. Our data identifies IGR, temporal lobe involvement and MCA with additional infarct were independent predictors of early surgery.