Evidence map›Paper›PMID 33352507›Full record

ArticleJournal of the neurological sciences2021

Risk profile of decompressive hemicraniectomy for malignant stroke after revascularization treatment.

Mohamed Alzayiani, Tobias Schmidt, Michael Veldeman, Alexander Riabikin, Marc A Brockmann, Johannes Schiefer, Hans Clusmann, Gerrit A Schubert, Walid Albanna

Abstract read
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In one paragraph

Article in Journal of the neurological sciences, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Hemorrhagic transformation following a malignant middle cerebral artery infarction.Journal of cerebrovascular and endovascular neurosurgery · 2026
    Article
  3. Article
  4. Article
  5. Observational
  6. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Mohamed AlzayianiDepartment of Neurosurgery, RWTH Aachen University, Aachen, Germany.
Tobias SchmidtDepartment of Neurosurgery, RWTH Aachen University, Aachen, Germany.
Michael VeldemanDepartment of Neurosurgery, RWTH Aachen University, Aachen, Germany.
Alexander RiabikinDepartment of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany.
Marc A BrockmannDepartment of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany; Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany.
Johannes SchieferDepartment of Neurology, RWTH Aachen University, Aachen, Germany.
Hans ClusmannDepartment of Neurosurgery, RWTH Aachen University, Aachen, Germany.
Gerrit A SchubertDepartment of Neurosurgery, RWTH Aachen University, Aachen, Germany.
Walid AlbannaDepartment of Neurosurgery, RWTH Aachen University, Aachen, Germany. Electronic address: WalidAlbanna@Yahoo.de.
RWTH Aachen University · DEJohannes Gutenberg University Mainz · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveRevascularization by pharmacological and/or endovascular treatment is an effective therapy for acute ischemic stroke caused by artery occlusion. In the context of malignant middle cerebral artery infarction (MMI), decompressive hemicraniectomy (DHC) can be life-saving. However, its effectiveness and safety after revascularization have not been thoroughly assessed. This retrospective study aimed to determine the risk profile of pre-surgical revascularization treatment (RT) for subsequent DHC.

methodsA total of 152 consecutive patients treated by DHC after MMI were identified between 2012 and 2015. After elimination of cases with previous stroke and cases pre-treated with antiplatelets or anticoagulants (increased postoperative bleeding), twenty-four out of fifty patients (n = 24/50, 48%) received pre-surgical revascularization treatment by intravenous thrombolysis (TL), mechanical thrombectomy (MT) or a combination of both. Demographic data was compared alongside perioperative, postoperative complications (intra-/extracerebral hemorrhage, revision surgery due to hemorrhage or infection, and overall mortality) and economic parameters.

resultsComparing patients with and without prior RT, there was no statistically significant difference in duration of surgery (RT: 83 [57-116] min vs. no-RT: 96 [69-119] min, p = 0.308), intraoperative blood loss (RT: 300 [225-375] ml vs. no-RT: 300 [250-400] ml, p = 0.763), intraoperative transfusion requirement (RT: 12.5% vs. no-RT: 26.9%, p = 0.294), or need for volume substitution (RT: 1300 [1200-1400] ml vs. no-RT: 1200 [1100-1400] ml, p = 0.359). The rate of postoperative complications was also comparable in both groups, including intra-/extracerebral hemorrhage, revision due to hemorrhage or infections, and mortality (p = 0.814, p = 0.520, p = 0.697, and p = 0.769). Health economic parameters were not affected (ventilation time: RT: 309 [12-527] hrs. vs. no-RT: 444 [171-605] hrs., p = 0.120, length of stay: RT: 23 [13-32] days vs. no-RT: 28 [19-41], p = 0.156, and stay costs: RT: 27768 [13044-60,248] € vs. no-RT: 35422 [21225-49,585] €, p = 0.312).

conclusionDHC for patients with MMI who previously received revascularization therapy appears to be safe and not associated with a higher complication rate or increased health economic burden.

Indexed as

Brain IschemiaDecompressive CraniectomyStrokeHumansInfarction, Middle Cerebral ArteryRetrospective StudiesTreatment OutcomeDecompressive hemicraniectomyMalignant middle cerebral artery infarction (MMI)Risk profileStrokeThrombectomyThrombolysis

Identifiers

PMID33352507
OpenAlexW3112387238

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.