Surgical Management of Acute Stroke

Jee-Hyun Kwon

doi:10.5124/jkma.2009.52.4.375

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Kwon: Surgical Management of Acute Stroke

Focused Issue of This Month

Acute Management of Stroke

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2009; 52(4): 375-381.

Published online: 30 April 2009

DOI: https://doi.org/10.5124/jkma.2009.52.4.375

Surgical Management of Acute Stroke

Jee-Hyun Kwon, MD

Department of Neurology, Ulsan University College of Medicine, Korea. jhkwon-or@hanmail.net

Abstract

Stroke is a most common neurological disease leading to mortality and morbidity. Many clinical evidences confirm that medical treatment including thrombolytic and antithrombotic therapy may improve the clinical outcome in patients with acute ischemic stroke. However, little information exists about effectiveness and safety of reperfusion surgery such as emergency carotid endarterectomy and extracranial-intracranial bypass surgery in patients with acute ischemic stroke and limits its wide application. Recent pooled analysis of three randomized controlled clinical trials-DECIMAL (decompressive craniectomy in malignant middle cerebral artery infarcts) trial; DESTINY (decompressive surgery for the treatment of malignant infarction of the middle cerebral artery) trial; and HAMLET (hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial) reported decompressive surgery undertaken within 48 hours of stroke onset in patients with malignant middle cerebral artery infarction reduced mortality and morbidity. However, decompressive surgery in patients with malignant middle cerebral artery infarction should be done according to the clinical conditions of individual patients. No clear evidences are present on that craniotomy, minimally invasive surgery, and early clot evacuation are effective on functional outcome of patients with spontaneous intracerebral hemorrhage compared with initial conservative therapy. In conclusion, a lot of well-designed studies are needed to recommend appropriate surgical management in patients with acute ischemic and hemorrhagic stroke.

Keywords: Malignant middle cerebral artery infarct, Decompressive surgery, Intracerebral hemorrhage

Figures and Tables

Figure 1

Distributions of the scores on the mRS and death after 12 months for patients treated with or without decompressive surgery (Adopted from Vahedi K, et al. Lancet Neurol 2007; 6: 218).

Figure 2

Absolute risk reductions and odds ratios for unfavourable outcome at 12 months (Adopted from Vahedi K, et al. Lancet Neurol 2007; 6: 218).

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