title: Decompressive Craniectomy for Ischemic Stroke: Effect of Hemorrhagic Transformation on Outcome.
abstract: BACKGROUND
  Decompressive hemicraniectomy (DhC) is a life-saving surgical procedure being increasingly employed for malignant middle cerebral artery strokes. We examined the incidence of hemorrhagic transformation following DhC.
  
  
  METHODS
  We retrospectively reviewed the charts and radiological images of patients who underwent DhC for malignant middle cerebral artery strokes. We classified the hemorrhagic events and assessed the short-term 30-day outcome associated with these events.
  
  
  RESULTS
  A total of 23 DhCs were performed for supratentorial ischemic strokes in 22 patients. There were 16 males and 6 females with an average age of 47 years (21-69 years). Of the 22 patients, 13 (59%) developed a new hemorrhage following DhC. There were 3 mortalities (14%). Of the survivors, 6 (27%) were discharged home with a modified Rankin Scale (mRS) score of 2. The remaining 13 patients (59%) recovered to a degree wherein they were discharged to a rehabilitation center (mRS score 3-4). No patient persisted in a vegetative or semivegetative state (mRS score 5).
  
  
  CONCLUSIONS
  In this study, the rate of hemorrhagic transformation following DhC for ischemic stroke was 59%. This is much higher than that reported in the stroke thrombolysis literature. The presence of any type of new hemorrhagic transformation in this patient population does not appear to alter the natural history of their ischemic strokes in terms of Glasgow outcome scores or destination of disposition.
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, King Fahad Hospital of the University, University of Dammam, Al-Khobar, Saudi Arabia. Electronic address: hjehani@uod.edu.sa.
authors.forename: Hosam
authors.initials: H
authors.lastname: Al-Jehani
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Petrecca
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Martel
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Sinclair
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute/Hospital, Department of Neurosurgery, McGill University Health Centers, McGill University, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Sirhan
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000601:surgery; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006474:Hemorrhagic Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: Malignant middle cerebral artery stroke; decompressive craniectomy; hemorrhagic transformation; intracerebral hemorrhage; intracranial pressure monitoring; microbleeds; reperfusion injury