Abstract 261: Mechanical thrombectomy in patients with large‐territory acute ischemic stroke requiring a decompressive hemicraniectomy

Abstract

Introduction Mechanical thrombectomy (MT) has demonstrated a significant improvement in functional outcomes for patients with anterior circulation strokes and large‐vessel occlusion (LVO). However, despite successful recanalization, certain patients still experience large hemispheric ischemia (LHI), necessitating decompressive hemicraniectomy (DHC). This study aims to investigate the characteristics and predictive factors associated with LHI requiring DHC in patients with successfully recanalized anterior circulation LVO, shedding light on potential factors influencing patient outcomes in this context. Methods We retrospectively analyzed 117 patients with LHI admitted to OLSU from November 2015 to March 2023. These individuals were then matched into two groups: a study group who had undergone decompressive hemicraniectomy (38) and a control group of individuals who had not (79). Additionally, within the DHC recipients, these individuals were further subgrouped into those who had undergone MT. Information was collected on demographic variables, medical history and clinical parameters. Functional outcomes were assessed via binarization of the following variables: the modified Rankin scale score on discharge (0‐4: good outcome vs. 5‐6: poor outcome). Results Among the 38 patients with LHI who underwent DHC (mean age 52.47 + 12.27 years, 63.1% males), 16 (42.1%) patients received intravenous tPA administration, and 13 (34%) underwent mechanical thrombectomy (MT) with successful reperfusion (TICI ≥ 2b) achieved in 8 (61.5%) of these patients. The assessment of the modified Rankin Scale (mRS) at discharge (0‐4: good outcome, 5‐6: poor outcome) revealed that both intravenous tPA (p‐value ‐ 0.206) and MT (p‐value 0.50) were not significantly associated with a good clinical outcome at discharge. Conclusion In the overall analysis of all individuals with complete outcome data, none of the variables (DHC receipt, MT receipt, tPA receipt) were significantly associated with mRS at discharge. The study did not find significant associations between the examined variables and the outcome (mRS on discharge) in patients with LHI who underwent DHC, regardless of whether they underwent reperfusion therapy or not. Advancements in acute ischemic stroke therapies such as thrombolytics and thrombectomy may reduce the need for DHC.