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Decompressive Hemicraniectomy in Elderly Patients With Space-Occupying Infarction (DECAP): A Prospective Observational Study

  • Jan Rahmig
  • Sigrid Wöpking
  • Eric Jüttler
  • Lorenz Uhlmann
  • Ronald Limprecht
  • Jessica Barlinn
  • Gabriele Schackert
  • Heinz Reichmann
  • Hauke SchneiderEmail author
Original Article
  • 107 Downloads

Abstract

Background

Decompressive hemicraniectomy improves survival rates and functional outcome in patients with space-occupying middle cerebral artery (MCA) infarction. We sought to determine clinical outcomes in elderly patients with MCA infarction treated with hemicraniectomy and to identify factors associated with functional outcome.

Methods

We performed a prospective, single-center observational study aiming to include patients aged ≥ 61 years with large MCA infarction treated with hemicraniectomy. The primary endpoint was the functional outcome according to modified Rankin Scale (mRS) score at 6 months after hemicraniectomy. Secondary endpoints included outcome measures at 12 months. A pooled analysis of individual patient data from the single-center cohort and a DESTINY 2 trial subgroup was performed to identify factors associated with functional status at 12 months.

Results

We included 40 MCA infarction patients who underwent hemicraniectomy between 2012 and 2017 at our university hospital (median [IQR] patient age 64 [62–67] years, National Institutes of Health Stroke Scale score 17 [16–21]). The dominant hemisphere was affected in 22/40 patients. Hemicraniectomy was performed within 31 [23–53] h of symptom onset. At 6 months after hemicraniectomy, 6/40 patients (15%) were moderately or moderately severely disabled (mRS score 3 or 4), 19 (47.5%) severely disabled (mRS score 5), and 15 (37.5%) had died. Compared to surgically treated DESTINY 2 patients, the single-center patients less likely exhibited favorable functional outcome at 6 months (mRS scores 0–4; odds ratio 0.239 [95% CI 0.082–0.696]). Case-fatality rate at 12 months was 43%. In a pooled analysis including 79 patients from DECAP and DESTINY 2, no significant associations of baseline and treatment factors with the clinical status at 12 months were observed.

Conclusions

In this single-center cohort of elderly patients with space-occupying MCA infarction and decompressive hemicraniectomy, the probability for survival without severe disability was low. Lethality at 6 and 12 months was comparable to previously reported data from a randomized trial.

Keywords

Stroke Space-occupying infarction Decompressive surgery Hemicraniectomy Prospective observational study Pooled analysis 

Notes

Acknowledgements

We thank the study patients and their relatives for their contribution to the study. The clinical study was conducted at the University Hospital, Technische Universität Dresden, Dresden, Germany. Statistical analyses were mainly performed at the Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.

Author Contributions

JR has acquired, analyzed and interpreted data. SW has acquired and interpreted data. EJ has provided data and interpreted data. LU has analyzed and interpreted data. RL has analyzed and interpreted data. JB has acquired and interpreted data. GS has interpreted data and provided administrative support. HR has interpreted data and provided administrative support. HS has designed and coordinated the study, has acquired, analyzed and interpreted data, and drafted the manuscript. All authors critically revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript.

Source of support

None.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interests.

Ethical Approval

The study was approved by the institutional review board (Ethikkommission an der TU Dresden; IRB00001473). Written informed consent was obtained from patients or their legal representatives.

Supplementary material

12028_2018_660_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Jan Rahmig
    • 1
  • Sigrid Wöpking
    • 1
  • Eric Jüttler
    • 2
  • Lorenz Uhlmann
    • 3
  • Ronald Limprecht
    • 3
  • Jessica Barlinn
    • 1
  • Gabriele Schackert
    • 4
  • Heinz Reichmann
    • 1
  • Hauke Schneider
    • 5
    • 6
    Email author return OK on get
  1. 1.Department of Neurology, University HospitalTechnische Universität DresdenDresdenGermany
  2. 2.Department of NeurologyOstalb-Klinikum AalenAalenGermany
  3. 3.Department Medical Biometry, Institute of Medical Biometry and Informatics (IMBI)University of HeidelbergHeidelbergGermany
  4. 4.Department of Neurosurgery, University HospitalTechnische Universität DresdenDresdenGermany
  5. 5.Medical FacultyTechnische Universität DresdenDresdenGermany
  6. 6.Department of NeurologyUniversity Hospital, University of AugsburgAugsburgGermany

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