title: Early decompressive surgery after combined intra-venous thrombolysis and endovascular stroke treatment.
abstract: OBJECTIVE
  The prognosis of malignant middle cerebral artery infarctions (MCA) is poor. The poor prognosis is attributable to the severe cerebral edema that causes a brain herniation and death. Decompressive surgery reduces mortality and may further improve patient outcomes. However, the safety and effectiveness of decompressive surgery in patients who underwent combined intravenous (IV) thrombolysis and endovascular stroke treatment are not certain. Moreover, the evidence on the timing of decompressive surgery is lacking.
  
  
  METHODS
  The purpose of the open, prospective and non-randomized study was to compare the outcome and complication rates of patients with malignant MCA strokes who underwent early decompressive surgery after combined intravenous thrombolysis and endovascular treatment with those of decompressive surgery patients without prior recanalization treatment strategy. All patients underwent decompressive surgery within 24h of symptom onset.
  
  
  RESULTS
  Thirty patients were included in the study. Twelve of the 30 patients were treated with combined IV thrombolysis and endovascular approach and 18 patients received standard treatment. The proportion of patients with a modified Rankin score ≤3 at the sixth month follow-up was 33% in the standard group and 44% in the combined treatment group (p=0.712). Mortality, and major and minor complications including symptomatic intracerebral hemorrhage after decompressive surgery did not differ between the two groups (p>0.05).
  
  
  CONCLUSIONS
  Early decompressive surgery can be safely performed in patients who received combined IV thrombolysis and endovascular treatment and there was no difference in outcome of these patients compared with patients who did receive the standard medical treatment before early decompressive surgery.
authors.affiliation: Eskisehir Osmangazi University, Department of Neurology, Neurocritical Care, Cerebrovascular Disease, Eskisehir, Turkey. Electronic address: aozcanozd@gmail.com.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Ozdemir
authors.affiliation: Eskisehir Osmangazi University, Department of Neurosurgery, Eskisehir, Turkey. Electronic address: zuhtuozbek@gmail.com.
authors.forename: Zuhtu
authors.initials: Z
authors.lastname: Ozbek
authors.affiliation: Eskisehir Osmangazi University, Department of Neurosurgery, Eskisehir, Turkey. Electronic address: mvural@ogu.edu.tr.
authors.forename: Murat
authors.initials: M
authors.lastname: Vural
authors.affiliation: Eskisehir Osmangazi University, Department of Neurosurgery, Eskisehir, Turkey. Electronic address: rdurmaz@ogu.edu.tr.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Durmaz
authors.affiliation: Eskisehir Osmangazi University, Department of Neurosurgery, Eskisehir, Turkey. Electronic address: erhancosan@ogu.edu.tr.
authors.forename: Erhan
authors.initials: E
authors.lastname: Cosan
authors.affiliation: Eskisehir Osmangazi University, Department of Neurosurgery, Eskisehir, Turkey. Electronic address: aali@ogu.edu.tr.
authors.forename: Ali
authors.initials: A
authors.lastname: Arslantas
authors.affiliation: Eskisehir Osmangazi University, Department of Neurosurgery, Eskisehir, Turkey. Electronic address: matasoy@edu.tr.
authors.forename: Metin Ant
authors.initials: MA
authors.lastname: Atasoy
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000009:adverse effects / Q000592:standards*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D010960:Plasminogen Activators
keywords: Decompressive surgery; Endovascular; Stroke; Thrombolysis