Abstract TMP11: Hemicraniectomy versus Conservative Treatment in Large Hemispheric Ischemic Stroke Patients

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Abstract

Background: Several small trials have inconclusively evaluated the effect of hemicraniectomy in reducing death and disability in acute ischemic stroke patients with large hemispheric infarctions.

Objective: To determine the effects of hemicraniectomy on clinical outcomes and mortality compared with conservative treatment in patients with large hemispheric infarctions.

Method: Six randomized trials that compared hemicraniectomy with conservative treatment in acute ischemic stroke patients met the inclusion criteria. We calculated pooled odds ratios and 95% CIs (confidence intervals) using random-effects models. The primary endpoint was a favorable outcome defined by a modified Rankin scale grade of 0 (no symptoms), 1 (no significant disability), 2 (slight disability), and 3 (moderate disability) at 180 days post-randomization.

Results: Of the 294 total subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to hemicraniectomy compared with conservative treatment (294 subjects analyzed, odds ratio 2.00, 95% CI 1.12-3.53, p=0.02). Survival was also significantly greater among those randomized to hemicraniectomy (294 subjects analyzed, odds ratio 5.18, 95% CI 3.10--8.68, p< .001). The odds of favorable outcome were significantly greater among those randomized to hemicraniectomy compared with conservative treatment in trials that permitted recruitment of patients aged ≥60 years (256 subjects analyzed, odds ratio 1.89, 95% CI 1.05-3.42, p=0.03).

Conclusions: Compared with conservative treatment, the odds of achieving a favorable outcome outcome at 6 months post-randomization is approximately 2 folds higher with hemicraniectomyin patients with large hemispheric infarctions

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