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Abstract Details

Evolution of Decompressive Hemicraniectomy Practice at a Single Academic Institution: Inclusion of Elderly Patients
Cerebrovascular Disease and Interventional Neurology
P4 - Poster Session 4 (5:30 PM-6:30 PM)
4-017

Evaluation of decompressive hemicranectomy (DH) in patients with large hemispheric infarcts at a single academic center.
Patients with malignant middle cerebral artery (MCA) - territory infarcts have high mortality and poor outcomes. Several randomized controlled trials (DECIMAL, DESTINY and HAMLET) demonstrate improved survival and functional outcomes for DH in patients under age 60 years and more recently for patients over 60 (DESTINY II). We reviewed data from our institution at two time points to compare the evolution in practice with respect to age and surgical timing.
We previously presented data for DH from 2003-2008 (Time1). We now conduct an updated review of all patients with large hemispheric strokes who underwent DH at a single academic institution from 2015-2019 (Time2). We compared age, admission NIHSS, and time to DH and for Time2 modified Rankin Scale (mRS) at discharge and 3 month follow-up. 

There were 31 patients at Time1 and 51 at Time2. Average age was 52(27-76) with 20% older than 60 at Time1 and 57(23-84) at Time2 with 40% older than 60. Mean NIHSS on admission was 18+/-3 at Time1 and 19 +/-7 at Time2. Average time to surgery was 48 hours at Time1 compared to 32 hours at Time2.  mRS at discharge for Time2 was 5.2 and at three month follow-up mRS was 4.4 with mortality of 40%.
Following DESTINY II, there has been increased volume of DH and higher percentage of older patients undergoing DH at our institution. Time to surgery improved by 16 hours reflecting earlier use of DH although it remains longer than RCTs that were within 24 hours. There was also a trend towards functional improvement at initial follow-up. Additional analysis is planned to compare outcomes relative to age, stroke type and functional outcome for surviving patients.
Authors/Disclosures
Amanda Opaskar, MD (UH Neurological Institute)
PRESENTER 		An immediate family member of Dr. Opaskar has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Avon Lake City Schools.
Reyanna Massaquoi, MD (Allina Health) No disclosure on file
Saad I. Yazdani, MD (Kaiser Permanente Sacramento Medical Center) Dr. Yazdani has nothing to disclose.
Michael A. De Georgia, MD (University Hospitals Cleveland Medical Center) Dr. De Georgia has nothing to disclose.
Cathy A. Sila, MD, FÂ鶹´«Ã½Ó³»­ (Neurological Institute Cleveland Medical Center) Dr. Sila has nothing to disclose.
Sophia Sundararajan, MD (University Hospitals of Cleveland) Dr. Sundararajan has stock in Boston Scientific Corp. Dr. Sundararajan has stock in Cisco Systems. Dr. Sundararajan has stock in Coca Cola Co. Dr. Sundararajan has stock in Cummins Inc. Dr. Sundararajan has stock in Hartford Insurance group. Dr. Sundararajan has stock in Johnson and Johnson. Dr. Sundararajan has stock in Merck and Company Inc. Dr. Sundararajan has stock in Microsoft. Dr. Sundararajan has stock in Netflix. Dr. Sundararajan has stock in Novartis. Dr. Sundararajan has stock in Oracle Corp. Dr. Sundararajan has stock in Pepsico. Dr. Sundararajan has stock in Proctor and Gamble. Dr. Sundararajan has stock in Qualcomm Inc. Dr. Sundararajan has stock in Travelers Cos Inc. Dr. Sundararajan has stock in Vertex Pharmacueticals. Dr. Sundararajan has stock in Visa Inc. Dr. Sundararajan has stock in Wallmart. Dr. Sundararajan has stock in Zoetis Inc Cl A. The institution of Dr. Sundararajan has received research support from NIH. The institution of Dr. Sundararajan has received research support from AHA.