Abstract：
BACKGROUND: Decompressive craniectomy (DC) reduces mortality without increasing the risk of very severe disability among patients with life-threatening massive cerebral infarction. However, its efficacy was demonstrated before the era of endovascular thrombectomy trials. It remains uncertain whether DC improves the prognosis of patients with malignant middle cerebral artery (MCA) infarction receiving endovascular therapy.
METHODS: We pooled data from two trials (DEVT and RESCUE BT studies in China) and patients with malignant MCA infarction were included to assess outcomes and heterogeneity of DC therapy effect. Patients with herniation were dichotomized into DC and conservative groups according to their treatment strategy. The primary outcome was the rate of mortality at 90 days. Secondary outcomes included disability level at 90 days as measured by the modified Rankin Scale score (mRS) and quality-of-life score. The associations of DC with clinical outcomes were performed using multivariable logistic regression.
RESULTS: Of 98 patients with herniation, 37 received DC surgery and 61 received conservative treatment. The median (interquartile range) was 70 (62-76) years and 40.8% of the patients were women. The mortality rate at 90 days was 59.5% in the DC group compared with 85.2% in the conservative group (adjusted odds ratio, 0.31 [95% confidence interval (CI), 0.10-0.94]; P=0.04). There were 21.6% of patients in the DC group and 6.6% in the conservative group who had a mRS score of 4 (moderately severe disability); and 10.8% and 4.9%, respectively, had a score of 5 (severe disability). The quality-of-life score was higher in the DC group (0.00 [0.00-0.14] vs 0.00 [0.00-0.00], P=0.004), but DC treatment was not associated with better quality-of-life score in multivariable analyses (adjusted β Coefficient, 0.02 [95% CI, -0.08-0.11]; p=0.75).
CONCLUSIONS: DC was associated with decreased mortality among patients with malignant MCA infarction who received endovascular therapy. The majority of survivors remained moderately severe disability and required improvement on quality of life.
BACKGROUND: The DEVT trial: http://www.chictr.org. Identifier, ChiCTR-IOR-17013568. The RESCUE BT trial: URL: http://www.chictr.org. Identifier, ChiCTR-INR-17014167.
METHODS: We pooled data from two trials (DEVT and RESCUE BT studies in China) and patients with malignant MCA infarction were included to assess outcomes and heterogeneity of DC therapy effect. Patients with herniation were dichotomized into DC and conservative groups according to their treatment strategy. The primary outcome was the rate of mortality at 90 days. Secondary outcomes included disability level at 90 days as measured by the modified Rankin Scale score (mRS) and quality-of-life score. The associations of DC with clinical outcomes were performed using multivariable logistic regression.
RESULTS: Of 98 patients with herniation, 37 received DC surgery and 61 received conservative treatment. The median (interquartile range) was 70 (62-76) years and 40.8% of the patients were women. The mortality rate at 90 days was 59.5% in the DC group compared with 85.2% in the conservative group (adjusted odds ratio, 0.31 [95% confidence interval (CI), 0.10-0.94]; P=0.04). There were 21.6% of patients in the DC group and 6.6% in the conservative group who had a mRS score of 4 (moderately severe disability); and 10.8% and 4.9%, respectively, had a score of 5 (severe disability). The quality-of-life score was higher in the DC group (0.00 [0.00-0.14] vs 0.00 [0.00-0.00], P=0.004), but DC treatment was not associated with better quality-of-life score in multivariable analyses (adjusted β Coefficient, 0.02 [95% CI, -0.08-0.11]; p=0.75).
CONCLUSIONS: DC was associated with decreased mortality among patients with malignant MCA infarction who received endovascular therapy. The majority of survivors remained moderately severe disability and required improvement on quality of life.
BACKGROUND: The DEVT trial: http://www.chictr.org. Identifier, ChiCTR-IOR-17013568. The RESCUE BT trial: URL: http://www.chictr.org. Identifier, ChiCTR-INR-17014167.
摘要：
背景：去骨瓣减压术（DC）可降低死亡率，而不会增加危及生命的大面积脑梗死患者严重残疾的风险。然而,其疗效在血管内血栓切除术试验之前得到证实.DC能否改善接受血管内治疗的恶性大脑中动脉（MCA）梗死患者的预后尚不确定。
方法：我们汇集了来自两项试验（中国的DEVT和RESCUEBT研究）的数据，并纳入了恶性MCA梗死患者，以评估DC治疗效果的结局和异质性。根据治疗策略将脑疝患者分为DC组和保守组。主要结果是90天的死亡率。次要结果包括90天时的残疾水平，通过改良的Rankin量表评分（mRS）和生活质量评分来衡量。使用多变量逻辑回归分析DC与临床结果的关联。
结果：在98例疝患者中，37例接受DC手术，61例接受保守治疗。中位数（四分位距）为70（62-76）年，40.8％的患者为女性。DC组90天的死亡率为59.5%，而保守组的死亡率为85.2%(调整后的比值比,0.31[95%置信区间(CI)，0.10-0.94]；P=0.04）。DC组中有21.6％的患者，保守组中有6.6％的患者mRS评分为4（中度重度残疾）；10.8％和4.9％，分别,得分为5分（严重残疾）。DC组的生活质量评分更高（0.00[0.00-0.14]vs0.00[0.00-0.00]，P=0.004),但在多变量分析中，DC治疗与更好的生活质量评分无关(校正后的β系数，0.02[95%CI，-0.08-0.11]；p=0.75)。
结论：DC与接受血管内治疗的恶性MCA梗死患者死亡率降低相关。大多数幸存者仍然是中度重度残疾，需要改善生活质量。
背景：DEVT试验：http://www。chictr.org.标识符,ChiCTR-IOR-17013568。RESCUEBT试验：URL：http：//www。chictr.org.标识符,ChiCTR-INR-17014167。
方法：我们汇集了来自两项试验（中国的DEVT和RESCUEBT研究）的数据，并纳入了恶性MCA梗死患者，以评估DC治疗效果的结局和异质性。根据治疗策略将脑疝患者分为DC组和保守组。主要结果是90天的死亡率。次要结果包括90天时的残疾水平，通过改良的Rankin量表评分（mRS）和生活质量评分来衡量。使用多变量逻辑回归分析DC与临床结果的关联。
结果：在98例疝患者中，37例接受DC手术，61例接受保守治疗。中位数（四分位距）为70（62-76）年，40.8％的患者为女性。DC组90天的死亡率为59.5%，而保守组的死亡率为85.2%(调整后的比值比,0.31[95%置信区间(CI)，0.10-0.94]；P=0.04）。DC组中有21.6％的患者，保守组中有6.6％的患者mRS评分为4（中度重度残疾）；10.8％和4.9％，分别,得分为5分（严重残疾）。DC组的生活质量评分更高（0.00[0.00-0.14]vs0.00[0.00-0.00]，P=0.004),但在多变量分析中，DC治疗与更好的生活质量评分无关(校正后的β系数，0.02[95%CI，-0.08-0.11]；p=0.75)。
结论：DC与接受血管内治疗的恶性MCA梗死患者死亡率降低相关。大多数幸存者仍然是中度重度残疾，需要改善生活质量。
背景：DEVT试验：http://www。chictr.org.标识符,ChiCTR-IOR-17013568。RESCUEBT试验：URL：http：//www。chictr.org.标识符,ChiCTR-INR-17014167。
