Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly: Comparison of outcomes between individuals 61-70 and >70 years of age

Joji Inamasu, Takafumi Kaito, Takeya Watabe, Tsukasa Ganaha, Yasuhiro Yamada, Teppei Tanaka, Shuei Imizu, Takuro Hayashi, Motoharu Hayakawa, Yoko Kato, Yuichi Hirose

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients >60 years of age has rarely been investigated. Methods: A retrospective study was conducted in a single academic institution. Surrogates of patients with clinical signs of impending brain herniation despite standard medical therapy were offered the option of DHC regardless of age or the side of the lesion. The clinical data from 18 patients >60 years of age who underwent DHC for malignant hemispheric infarction in our institution were analyzed. Patients were classified into the following 2 groups: 61-70 and >70 years of age, and their demographics and surgical outcomes were compared. The variables compared included the male:female ratio, side of the lesion, type of stroke, site of vascular occlusion, use of thrombolytic therapy, National Institutes of Health Stroke Scale score, stroke onset-to-DHC interval, duration of hospital stay, infectious complications, and 90-day mortality rate. Results: There were no significant intergroup differences in any of the demographic variables evaluated. However, the 30-day mortality rate was significantly higher in the group that was >70 years of age (0% v 60%; P =.01) than in the group that was 61 to 70 years of age. Conclusions: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients >70 years of age would benefit from DHC.

Original languageEnglish
Pages (from-to)1350-1354
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number8
DOIs
Publication statusPublished - 01-01-2013

Fingerprint

Stroke
Infarction
Mortality
Demography
Thrombolytic Therapy
National Institutes of Health (U.S.)
Blood Vessels
Length of Stay
Retrospective Studies
Brain
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Inamasu, Joji ; Kaito, Takafumi ; Watabe, Takeya ; Ganaha, Tsukasa ; Yamada, Yasuhiro ; Tanaka, Teppei ; Imizu, Shuei ; Hayashi, Takuro ; Hayakawa, Motoharu ; Kato, Yoko ; Hirose, Yuichi. / Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly : Comparison of outcomes between individuals 61-70 and >70 years of age. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 8. pp. 1350-1354.
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abstract = "Background: Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients >60 years of age has rarely been investigated. Methods: A retrospective study was conducted in a single academic institution. Surrogates of patients with clinical signs of impending brain herniation despite standard medical therapy were offered the option of DHC regardless of age or the side of the lesion. The clinical data from 18 patients >60 years of age who underwent DHC for malignant hemispheric infarction in our institution were analyzed. Patients were classified into the following 2 groups: 61-70 and >70 years of age, and their demographics and surgical outcomes were compared. The variables compared included the male:female ratio, side of the lesion, type of stroke, site of vascular occlusion, use of thrombolytic therapy, National Institutes of Health Stroke Scale score, stroke onset-to-DHC interval, duration of hospital stay, infectious complications, and 90-day mortality rate. Results: There were no significant intergroup differences in any of the demographic variables evaluated. However, the 30-day mortality rate was significantly higher in the group that was >70 years of age (0{\%} v 60{\%}; P =.01) than in the group that was 61 to 70 years of age. Conclusions: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients >70 years of age would benefit from DHC.",
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Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly : Comparison of outcomes between individuals 61-70 and >70 years of age. / Inamasu, Joji; Kaito, Takafumi; Watabe, Takeya; Ganaha, Tsukasa; Yamada, Yasuhiro; Tanaka, Teppei; Imizu, Shuei; Hayashi, Takuro; Hayakawa, Motoharu; Kato, Yoko; Hirose, Yuichi.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 8, 01.01.2013, p. 1350-1354.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Decompressive hemicraniectomy for malignant hemispheric stroke in the elderly

T2 - Comparison of outcomes between individuals 61-70 and >70 years of age

AU - Inamasu, Joji

AU - Kaito, Takafumi

AU - Watabe, Takeya

AU - Ganaha, Tsukasa

AU - Yamada, Yasuhiro

AU - Tanaka, Teppei

AU - Imizu, Shuei

AU - Hayashi, Takuro

AU - Hayakawa, Motoharu

AU - Kato, Yoko

AU - Hirose, Yuichi

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients >60 years of age has rarely been investigated. Methods: A retrospective study was conducted in a single academic institution. Surrogates of patients with clinical signs of impending brain herniation despite standard medical therapy were offered the option of DHC regardless of age or the side of the lesion. The clinical data from 18 patients >60 years of age who underwent DHC for malignant hemispheric infarction in our institution were analyzed. Patients were classified into the following 2 groups: 61-70 and >70 years of age, and their demographics and surgical outcomes were compared. The variables compared included the male:female ratio, side of the lesion, type of stroke, site of vascular occlusion, use of thrombolytic therapy, National Institutes of Health Stroke Scale score, stroke onset-to-DHC interval, duration of hospital stay, infectious complications, and 90-day mortality rate. Results: There were no significant intergroup differences in any of the demographic variables evaluated. However, the 30-day mortality rate was significantly higher in the group that was >70 years of age (0% v 60%; P =.01) than in the group that was 61 to 70 years of age. Conclusions: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients >70 years of age would benefit from DHC.

AB - Background: Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients >60 years of age has rarely been investigated. Methods: A retrospective study was conducted in a single academic institution. Surrogates of patients with clinical signs of impending brain herniation despite standard medical therapy were offered the option of DHC regardless of age or the side of the lesion. The clinical data from 18 patients >60 years of age who underwent DHC for malignant hemispheric infarction in our institution were analyzed. Patients were classified into the following 2 groups: 61-70 and >70 years of age, and their demographics and surgical outcomes were compared. The variables compared included the male:female ratio, side of the lesion, type of stroke, site of vascular occlusion, use of thrombolytic therapy, National Institutes of Health Stroke Scale score, stroke onset-to-DHC interval, duration of hospital stay, infectious complications, and 90-day mortality rate. Results: There were no significant intergroup differences in any of the demographic variables evaluated. However, the 30-day mortality rate was significantly higher in the group that was >70 years of age (0% v 60%; P =.01) than in the group that was 61 to 70 years of age. Conclusions: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients >70 years of age would benefit from DHC.

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