title: Impact of the Implementation of Thrombectomy with Stent Retrievers on the Frequency of Hemicraniectomy in Patients with Acute Ischemic Stroke.
abstract: BACKGROUND
  The increasing use of endovascular treatments has led to higher recanalization rates and better clinical outcomes compared with intravenous thrombolysis alone. Stent retrievers represent the latest development for recanalization of large vessel occlusions. Decompressive hemicraniectomy has proved beneficial in patients suffering from rising intracranial pressure after malignant stroke.
  
  
  OBJECTIVE
  We investigated the effect of the implementation of stent retriever treatment on the frequency of hemicraniectomy as a surrogate marker for infarct size and thus for poor neurological outcome.
  
  
  METHODS
  Patients with acute ischemic stroke were retrospectively studied. We compared the frequency of hemicraniectomy following proximal artery occlusion of the internal carotid artery and middle cerebral artery main stem in the years before (2009 and 2010) and after (2012 and 2013) introducing stent retrievers.
  
  
  RESULTS
  Overall, 497 patients with proximal arterial occlusion were included in the study. Of 253 patients admitted in the years 2009 and 2010 44 (17.4 %) and of 244 patients admitted in 2012 and 2013, 20 (8.2 %) received a hemicraniectomy. This decrease in the proportion of hemicraniectomies was statistically significant (p < 0.01).
  
  
  CONCLUSIONS
  The findings in this study illustrate a significantly reduced rate of hemicraniectomies in patients with proximal artery occlusions after implementation of thrombectomy with stent retriever. Hereby, we could show a significant reduction of malignant infarctions after thrombectomy with stent retriever.
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. peter.sporns@ukmuenster.de.
authors.forename: P B
authors.initials: PB
authors.lastname: Sporns
authors.affiliation: Department of Neurology, University Hospital Münster, Münster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Minnerup
authors.affiliation: Department of Neurosurgery, University Hospital Münster, Münster, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Warneke
authors.affiliation: Department of Neurology, University Hospital Münster, Münster, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Dziewas
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Hanning
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Berkemeyer
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Zoubi
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Heindel
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schwindt
authors.affiliation: Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Niederstadt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D020878:Device Removal / Q000295:instrumentation / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000706:statistics & numerical data*
keywords: Acute ischemic stroke; Hemicraniectomy; Stent retriever; Thrombectomy