Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial
Abstract Decompressive hemicraniectomy (DHC) can improve outcomes for patients with severe forms of acute ischemic stroke (AIS), but the evidence is mainly derived from non-thrombolyzed patients. We aimed to determine the characteristics and outcomes of early DHC in thrombolyzed AIS participants of...
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2021
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oai:doaj.org-article:a974831cf19a46888d63292251791d012021-12-02T19:06:35ZEarly decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial10.1038/s41598-021-96087-z2045-2322https://doaj.org/article/a974831cf19a46888d63292251791d012021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-96087-zhttps://doaj.org/toc/2045-2322Abstract Decompressive hemicraniectomy (DHC) can improve outcomes for patients with severe forms of acute ischemic stroke (AIS), but the evidence is mainly derived from non-thrombolyzed patients. We aimed to determine the characteristics and outcomes of early DHC in thrombolyzed AIS participants of the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Post-hoc analyses of ENCHANTED, an international, partial-factorial, open, blinded outcome-assessed, controlled trial in 4557 thrombolysis-eligible AIS patients randomized to low- versus standard-dose intravenous alteplase (Arm A, n = 2350), intensive versus guideline-recommended blood pressure control (Arm B, n = 1280), or both (Arms A + B, n = 947). Logistic regression models were used to identify baseline variables associated with DHC, with inverse probability of treatment weights employed to eliminate baseline imbalances between those with and without DHC. Logistic regression was also used to determine associations of DHC and clinical outcomes of death/disability, major disability, and death (defined by scores 2–6, 3–5, and 6, respectively, on the modified Rankin scale) at 90 days post-randomization. There were 95 (2.1%) thrombolyzed AIS patients who underwent DHC, who were significantly younger, of non-Asian ethnicity, and more likely to have had prior lipid-lowering treatment and severe neurological impairment from large vessel occlusion than other patients. DHC patients were more likely to receive other management interventions and have poor functional outcomes than non-DHC patients, with no relation to different doses of intravenous alteplase. Compared to other thrombolyzed AIS patients, those who received DHC had a poor prognosis from more severe disease despite intensive in-hospital management.Chao XiaXia WangRichard I. LindleyCandice DelcourtXiaoying ChenZien ZhouRui GuoCheryl CarcelAlejandra MalaveraZeljka CalicGrant MairJoanna M. WardlawThompson G. RobinsonCraig S. AndersonNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-7 (2021) |
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Medicine R Science Q Chao Xia Xia Wang Richard I. Lindley Candice Delcourt Xiaoying Chen Zien Zhou Rui Guo Cheryl Carcel Alejandra Malavera Zeljka Calic Grant Mair Joanna M. Wardlaw Thompson G. Robinson Craig S. Anderson Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial |
| description |
Abstract Decompressive hemicraniectomy (DHC) can improve outcomes for patients with severe forms of acute ischemic stroke (AIS), but the evidence is mainly derived from non-thrombolyzed patients. We aimed to determine the characteristics and outcomes of early DHC in thrombolyzed AIS participants of the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Post-hoc analyses of ENCHANTED, an international, partial-factorial, open, blinded outcome-assessed, controlled trial in 4557 thrombolysis-eligible AIS patients randomized to low- versus standard-dose intravenous alteplase (Arm A, n = 2350), intensive versus guideline-recommended blood pressure control (Arm B, n = 1280), or both (Arms A + B, n = 947). Logistic regression models were used to identify baseline variables associated with DHC, with inverse probability of treatment weights employed to eliminate baseline imbalances between those with and without DHC. Logistic regression was also used to determine associations of DHC and clinical outcomes of death/disability, major disability, and death (defined by scores 2–6, 3–5, and 6, respectively, on the modified Rankin scale) at 90 days post-randomization. There were 95 (2.1%) thrombolyzed AIS patients who underwent DHC, who were significantly younger, of non-Asian ethnicity, and more likely to have had prior lipid-lowering treatment and severe neurological impairment from large vessel occlusion than other patients. DHC patients were more likely to receive other management interventions and have poor functional outcomes than non-DHC patients, with no relation to different doses of intravenous alteplase. Compared to other thrombolyzed AIS patients, those who received DHC had a poor prognosis from more severe disease despite intensive in-hospital management. |
| format |
article |
| author |
Chao Xia Xia Wang Richard I. Lindley Candice Delcourt Xiaoying Chen Zien Zhou Rui Guo Cheryl Carcel Alejandra Malavera Zeljka Calic Grant Mair Joanna M. Wardlaw Thompson G. Robinson Craig S. Anderson |
| author_facet |
Chao Xia Xia Wang Richard I. Lindley Candice Delcourt Xiaoying Chen Zien Zhou Rui Guo Cheryl Carcel Alejandra Malavera Zeljka Calic Grant Mair Joanna M. Wardlaw Thompson G. Robinson Craig S. Anderson |
| author_sort |
Chao Xia |
| title |
Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial |
| title_short |
Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial |
| title_full |
Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial |
| title_fullStr |
Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial |
| title_full_unstemmed |
Early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international ENCHANTED trial |
| title_sort |
early decompressive hemicraniectomy in thrombolyzed acute ischemic stroke patients from the international enchanted trial |
| publisher |
Nature Portfolio |
| publishDate |
2021 |
| url |
https://doaj.org/article/a974831cf19a46888d63292251791d01 |
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