Publications
Decompressive Hemicraniectomy Following Mechanical Thrombectomy for Malignant Ischemic Stroke: A Single-Centre Retrospective Study
Dr Rahul Jain, Dr Karthik C, Dr Rehana Begum, Dr Zothansanga Zadeng, Prof Dr Rajesh R Raykar, Prof Dr Shailesh AV Rao Abstract: Introduction: Decompressive hemicraniectomy (DHC) reduces mortality in malignant middle cerebral artery infarction, but most landmark trials predated routine mechanical thrombectomy (MT). Contemporary data from low- and middle-income countries remain limited.
Objective: To describe indications, timing, surgical complications, and functional outcomes of DHC in patients with anterior-circulation ischemic stroke who underwent MT at a tertiary neurosurgical center in India, and to compare results with modern international series.Methods: We retrospectively reviewed consecutive adults with anterior-circulation large-vessel occlusion who underwent MT between December 2023 and December 2025. Of 55 MT patients, 32 progressed to malignant infarction requiring ipsilateral DHC. Demographics, risk factors, NIHSS, imaging, treatment timelines, complications, and modified Rankin Scale (mRS) at discharge and 3 months were analyzed.
Results: 58.2% (32/55) of MT-treated patients required DHC. Compared with MT-only patients, the MT+DHC cohort was slightly younger (median age 56 vs 61 years) with higher baseline NIHSS (19 vs 15). Successful reperfusion (TICI 2b–3) was achieved in 78.1%. Median onset-to-DHC time was 38 h (65.6% within 48 h). Surgical complications occurred in 12.5%; revision surgery was needed in 6.3%. In-hospital mortality was 21.9%. At 3 months, favorable outcome (mRS 0–2) was achieved in 25.0%, with mRS 3 in 21.9%. Outcomes and complication rates were comparable to contemporary thrombectomy-era DHC series.
Conclusions: In this Indian cohort, more than half of MT-treated patients required DHC for malignant edema. Prior MT and bridging thrombolysis did not increase surgical risk. DHC remains a safe and effective rescue therapy in the modern endovascular era, even in resource-constrained settings. Multicenter South-Asian registries are warranted.
Keywords: malignant middle cerebral artery infarction, decompressive hemicraniectomy, mechanical thrombectomy, large-vessel occlusion, India
