title: Decompressive craniectomy after intravenous tissue plasminogen activator administration for stroke.
abstract: OBJECTIVE
  Intravenous tissue plasminogen activator (IV tPA) is an approved treatment for acute ischemic stroke. However, the effects of decompressive craniectomy (DC) after IV tPA administration for ischemic stroke are still largely unknown. The aim of this study was to investigate the safety and outcomes of DC after IV tPA administration.
  
  
  METHODS
  We retrospectively reviewed patients who underwent DC for malignant hemispheric infarction. We compared 20 patients who underwent DC after IV tPA administration with another 20 patients who underwent DC without prior IV tPA administration.
  
  
  RESULTS
  The patient characteristics did not differ between the DC patients with and without prior IV tPA administration. New intracranial bleeding or worsening of pre-existing ICH occurred in two patients (10%) in each group. Furthermore, the rates of an mRS score of 4-6, 5 or 6, and 6 did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  DC may be a safe and useful surgical procedure for space-occupying edema after IV tPA administration for acute stroke.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Saitama, Japan. s.takeuchi@room.ocn.ne.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Kojiro
authors.initials: K
authors.lastname: Wada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nawashiro
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Arimoto
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ohkawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Masaoka
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takasato
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator