Introduction: Patients presenting with large-territory ischemic strokes may develop intractable cerebral edema that risks death unless intervention is performed. The purpose of this study is to identify predictors of outcome for decompressive hemicraniectomy (DH) in ischemic stroke.

Methods: Retrospective electronic medical record review of 1,624 subjects from 2006 to 2014 was conducted. Subjects were screened for DH secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery or both. 95 subjects were identified. Univariate and multivariate analyses were performed for an array of clinical variables in relationship to functional outcome according to the modified Rankin Scale (mRS).

Results: Mean mRS score at 90 days post-DH was 4. Good functional outcome was observed in 40% of patients and mortality at 90 days was 18%. Univariate analysis identified a greater likelihood of poor functional outcome (mRS 4-6) in patients with previous history of stroke (OR = 6.54; p = 0.017; [1.39-30.66]), peak midline shift (MLS) >10mm (OR = 3.35; p = 0.011; [1.33-8.47]), or history of myocardial infarction (OR = 8.95; p = 0.04; [1.10-72.76]). Multivariate analysis demonstrated elevated odds of poor functional outcome for previous history of stroke (OR = 9.14; p = 0.008; [1.78-47.05]), MLS >10mm (OR = 5.08; p = 0.002; [1.79-14.36]), history of diabetes (OR=3.07; [1.03-9.16]; P=0.045) and delayed time from onset of stroke to DH (OR=1.32; [1.02-1.72]; P=0.037).

Conclusions: History of stroke, diabetes, MI, peak MLS >10mm and increasing duration from onset of stroke to decompressive hemicraniectomy are associated with a worse functional outcome.

Patient Care: This paper will help physicians to make a better patient selection for decompressive hemicraniectomy by providing predictors of clinical outcome after the procedure.

Learning Objectives: To identify predictors of outcome for decompressive hemicraniectomy (DH) in the treatment of acute ischemic stroke.

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