Analysis Of The Safety Of Decompressive Craniectomy After Mechanical Thrombectomy And Influence On The Prognosis Of Decompressive Craniectomy

Objective: To evaluate the safety of decompressive craniectomy(DC)in patients with malignant cerebral infarction after mechanical thrombectomy(MT)and to explore the related factors that influence the intracranial hemorrhage transformation and mortality after DC.Methods: Retrospective analysis of the DC preoperative data,intracranial hemorrhage transformation and mortality of 45 patients for cerebral infarction and treated with DC.All patients were divided into MT + DC group and DC group based on whether they received MT before DC.The clinical baseline data such as patient age,gender,stroke risk factors,cerebral hernia,and Glasgow Coma Scale(GCS)score before DC and the National Institute of Health stroke scale(NIHSS)scores before DC,etc,intracranial hemorrhage transformation,in-hospital mortality,and neurological recovery of surviving patients were analyzed in both groups.Various factors such as age,gender,stroke risk factors,NIHSS score,GCS score,anticoagulation and antiplatelet use before DC and time from onset to DC etc,were analyzed on the influence of postoperative DC on intracranial hemorrhage transformation and mortality.Results: A total of 45 patients were admitted for acute ischemic stroke after conservative medical treatment or endovascular intervention.DC treatment for patients who have deteriorated after previous treatment.There were 25 patients who had been treated with MT before DC surgery and 20 patients who had not been treated with MT before DC surgery.Intracranial hemorrhage transformation occurred in 17(38%)of the 45 patients,8(18%)died during hospitalization,and 6(16%)of the surviving patients achieved good prognosis.There was a statistically significant difference in the GCS score before DC between the MT + DC group and the DC group(P = 0.044).Other baseline data such as gender,age,stroke risk factors,anticoagulation and antiplatelet use before DC and coagulation function were not statistical difference.12(48%)patients in the MT + DC group had intracranial hemorrhage transformation after DC,and 5 patients(25%)in the DC group had intracranial hemorrhage transformation after DC,there was no statistical difference between the two groups(P = 0.114).There was no significant difference in the length of hospitalization between the MT + DC group and the DC group of 30.68 and 33.95days(P = 0.880).There were no significant differences in the Modified Rankin Scale(m RS)scores and in-hospital mortality between the MT + DC group and the DC group(P = 0.526,P = 0.965).6 patients in the MT + DC group had good m RS scores at discharge,while those in the DC group had poor m RS scores at discharge.Analysis of factors related to intracranial hemorrhage transformation after DC.There were 17 patients in the intracranial hemorrhage transformation group after DC and 28 patients in the no intracranial hemorrhage transformation group after DC.There were statistically significant differences between the two groups of GCS score before the DC and the time from onset to DC(P = 0.039,P = 0.028).The in-hospital mortality rate after DC was found to be related to the GCS and NIHSS scores of patients before DC(both P = 0.04).Conclusions: MT has no significant effect on the intracranial hemorrhage transformation and mortality after DC.It is safe to perform DC after MT.The preoperative GCS score and the time from onset to DC may be factors influencing the intracranial hemorrhage transformation after DC,and the mortality rate after DC may be related to the patient’s condition before DC.