Clinical and radiographic risk indicators for decompressive hemicraniectomy in patients with ischemic stroke: an institutional and national analysis

Malignant cerebral edema is a common and devastating consequence of ischemic stroke that could necessitate decompressive hemicraniectomy to prevent herniation. Multiple randomized control trials have reported the utility of this surgery in reducing morbidity and mortality associated with edema following stroke and more recent national data analysis revealed that incident of decompressive procedures was reduced following the widespread use of thrombectomy for stroke treatment. In the current study we looked at data from our institution to identify key features on initial and short interval CT scans which can predict at risk patients for decompressive surgery. In addition, we looked at clinical risk factors in patients who suffer from stroke and undergo mechanical thrombectomy. We found that easy to identify features on CT scan are significantly more frequent in patients who eventually require decompressive procedures especially within the first 24 h. Younger patients with associate vessel dissections and electrolyte abnormalities were at higher risk of requiring decompression surgery following stroke and mechanical thrombectomy.