title: Safety and outcomes of decompressive craniectomy after intravenous tissue plasminogen activator administration for malignant cerebral infarction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the safety and outcomes of decompressive craniectomy (DC) after intravenous tissue plasminogen activator (IV tPA) administration for malignant cerebral infarction.
  
  
  METHODS
  We retrospectively reviewed patients who underwent DC for malignant cerebral infarction. We compared fourteen patients who underwent DC after IV tPA administration with another nine patients who underwent DC without prior IV tPA administration.
  
  
  RESULTS
  Twenty-three patients underwent DC for malignant hemispheric cerebral infarction in our hospital for five years. Fibrinolysis was performed prior to the DC in fourteen patients (60,9%). The patients characteristics did not differ between the DC patients with and without prior IV tPA administration. The complications that developed after DC were similar in both groups: in patients who underwent DC after IV tPA administration, 9 (64.3%) developed haemorrhagic transformation and 6 (42.9%) developed hydrocephalus. The functional outcome, as the 6-month GOS, was similar in both groups (p = 0.762). ICU mortality (p = 0.329) and hospital mortality after ICU (p= 0.634) were also similar between the two groups.
  
  
  CONCLUSIONS
  Although the main limitation is that the number of patients in our serie was small, which reduced the statistical power, our study suggest that DC after failure of IV tPA administration for malignant cerebral infarction is safe and did not cause an excess of complications arising from the use of fibrinolytic.
authors.affiliation: a Intensive Care Department , Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, España , Canary Islands , Spain.
authors.forename: Luciano
authors.initials: L
authors.lastname: Santana-Cabrera
authors.affiliation: a Intensive Care Department , Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, España , Canary Islands , Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ocampo-Pérez
authors.affiliation: a Intensive Care Department , Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, España , Canary Islands , Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Rodríguez-Escot
authors.affiliation: a Intensive Care Department , Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, España , Canary Islands , Spain.
authors.forename: Marcos
authors.initials: M
authors.lastname: Granados-Rodríguez
authors.affiliation: a Intensive Care Department , Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, España , Canary Islands , Spain.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodríguez-Pérez
mesh_terms: D000328:Adult; D000368:Aged; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy* / Q000601:surgery; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000601:surgery*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Decompressive craniectomy; neurosurgical intensive care; outcome; stroke