Decompressive craniectomy for malignant cerebral edema in patients with mechanical thrombectomy for stroke

Abstract Background Malignant cerebral edema is a life-threatening complication after stroke. We focused on the clinical impact of decompressive craniectomy (DC) in patients after mechanical thrombectomy (MT) for large vessel occlusion. The aim of the study was to define predictors of a good clinical outcome. Results Patients from our center’s registry (1306 patients who underwent MT between 2008 and 2022, most of whom received simultaneous intravenous thrombolysis (IVT)) who underwent DC for malignant cerebral edema were included in the retrospective study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and clinical outcome with modified Rankin scale (mRS). Considering the extent of cerebral impairment, we consider achieving at least partial mobility with assistance (mRS ≤ 4) to be a good result. Predictors of clinical outcome were evaluated. DC was performed in 46 patients (3.5% of all performed MT). A mRS ≤ 3 was achieved by 13% within 3 months and 22% within 1 year (In patients younger than 60 years 36%. A mRS ≤ 4 was achieved by 22% within 3 months and 24% within 1 year. Three-month mortality was 41%. A predictor of a poor outcome was higher age ( p = 0.003), the presence of comorbidities (,ischemic heart disease- p = 0.019,hyperlipidemia- p = 0.025,) and unsuccessful recanalization during MT ( p = 0.04). Conclusions Malignant edema after stroke has a poor prognosis. However, even patients with DC performed in early follow-up to MT can achieve a relatively good clinical condition.