Introduction: The increased area of infarction associated with malignant internal carotid artery (ICA) is thought to portend a poorer prognosis when compared with middle cerebral artery (MCA) infarction and as such Decompressive craniectomy (DC) has not been routinely recommended. The authors sought to compare the functional outcomes and survival between patients with ICA infarctions and those with MCA infarctions after DC in the largest series to date.
Methods: A multicenter retrospective review of 154 consecutive DCs for large territory cerebral infarctions performed from 2005 to 2020. Univariate and multivariate analyses were performed for the clinical exposures for functional outcomes (modified Rankin Scale [mRS] score) on discharge and at the 1- and 6-month follow-ups, and for mortality, both inpatient and at the 1-year follow-up. A favorable mRS score was defined as 0–2.
Results: There were 67 patients (43.5%) and 87 patients (56.5%) in the ICA and MCA groups, respectively. Univariate analysis showed that the ICA group had a comparably favorable mRS (OR 0.15 [95% CI 0.18–1.21], p = 0.077), Inpatient mortality (OR 1.79 [95% CI 0.79–4.03], p = 0.16) and 1-year mortality (OR 2.07 [95% CI 0.98–4.37], p = 0.054). After adjustment, a favorable mRS score at 6 months (OR 0.17 [95% CI 0.018–1.59], p = 0.12), inpatient mortality (OR 1.02 [95% CI 0.29–3.57], p = 0.97), and 1-year mortality (OR 0.94 [95% CI 0.41–2.69], p = 0.88) were similar in both groups. The overall survival using the Cox proportional hazard regression, did not show any significant difference (HR 0.581).
Conclusion : Unlike previous smaller studies, this study found that patients with malignant ICA infarction had a functional outcome and survival that was similar to those with MCA infarction after DC. Therefore, DC can be offered for malignant ICA infarction for life-saving purposes with limited functional recovery.
