Journal article
Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry
Neurosurgery, Vol.98(2), pp.345-357
02/2026
DOI: 10.1227/neu.0000000000003563
PMID: 40488514
Abstract
It remains unclear whether decompressive craniectomy (DC) is beneficial in patients who suffer symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke (AIS). We sought to study the effect of DC on functional outcomes in patients with sICH after AIS who underwent mechanical thrombectomy (MT).
Patients with AIS from anterior circulation large vessel occlusion who underwent MT and subsequently developed sICH were identified from the Stroke Thrombectomy and Aneurysm Registry database. The primary outcome was acceptable 90-day functional neurological outcome, defined as modified Rankin scale (mRS) 0-3. Multivariable logistic regression and propensity-score matching were used to identify and quantify risk factors.
Of 464 patients identified with sICH after AIS after MT, 97 patients (20.9%) underwent DC. Patients who underwent DC were more likely to be female (P < .001), younger (P < .001), have a measured medical comorbidity, have higher baseline mRS (P = .02), and have higher-grade hemorrhages (P = .01). At 90 days, 14% of patients had the primary outcome of mRS 0-3 and 56% had died. The primary outcome was observed in 11 patients who underwent DC (11%) and 55 (15%) of those without DC (odds ratio [OR] 0.7, 95% CI 0.4-1.4, P = .40). DC did not affect mRS shift at 90 days (P = .10) but was associated with lower mortality (OR 0.5, 95% CI 0.3-0.8, P = .01). Multivariable analysis demonstrated that DC decreased the odds of primary outcome (adjusted OR 0.2, 95% CI 0.02-0.9, P = .045), but did not affect mortality (P = .94), mRS shift (P = .50), or length of stay (P = .90). Propensity-matched analysis similarly demonstrated that non-DC patients were more likely to achieve the primary outcome (24% vs 8%, P = .045).
In patients with sICH after AIS after MT, those selected for DC had less favorable outcomes and similar rates of mortality at 90 days.
Details
- Title: Subtitle
- Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry
- Creators
- Elliot Pressman - University of South FloridaKunal Vakharia - University of South FloridaWaldo R Guerrero - University of South FloridaMohammad-Mahdi Sowlat - Medical University of South CarolinaSamantha Schimmel - University of South FloridaIlko Maier - Universitätsmedizin GöttingenAnsaar Raai - West Virginia UniversityPascal Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam National University HospitalJonathan A Grossberg - Emory University School of MedicineAli Alawieh - Emory University School of MedicineStacey Q Wolfe - Wake Forest UniversityRobert M Stark - University of MiamiMarios-Nikos Psychogios - University of BaselEdgar A Samaniego - University of IowaNitin Goyal - University of Tennessee Health Science CenterJustin Dye - Loma Linda UniversityAli Alaraj - University of Illinois Urbana-ChampaignShinichi Yoshimura - Hyogo Medical UniversityMohamad Ezzeldin - University of HoustonDavid Fiorella - Stony Brook UniversityOmar Tanweer - NYU Langone HealthDaniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaPedro Navia - Hospital Universitario La PazHugo Cuellar - Louisiana State University Health Sciences Center ShreveportIsabel Fragata - Unidade Local de Saúde de São JoséAdam Polifka - Department of Neurosurgery, University of Florida, Gainesville, Florida, USAJustin Mascitelli - The University of Texas at San Antonio Health Science CenterJoshua Osbun - Washington University in St. Louis School of MedicineFazeel Siddiqui - Neurosciences, University of Michigan Health-West, Wyoming, Michigan, USAMark Moss - Washington Regional Medical CenterKaustubh Limaye - Indiana University BloomingtonCharles Matouk - University of New HavenMin S Park - University of VirginiaWaleed Brinjikji - Mayo ClinicErgun Daglioglu - Ankara (Czechia)Richard Williamson Jr - Allegheny Health NetworkDavid J Altschul - Montefiore Medical CenterChristopher S Ogilvy - Beth Israel Deaconess Medical CenterRoberto Crosa - Universidad de MontevideoMichael R Levitt - University of Washington School of MedicineBenjamin Gory - Centre Hospitalier Régional et Universitaire de NancyRamesh Grandhi - University of UtahAlexandra R Paul - Albany Medical Center HospitalPeter Kan - The University of Texas Medical Branch at GalvestonWalter Casagrande - Hospital FernándezShakeel Chowdhry - NorthShore University HealthSystemMichael F Stiefel - Piedmont Atlanta HospitalAlejandro M Spiotta - Medical University of South CarolinaMaxim Mokin - University of South FloridaStroke Thrombectomy and Aneurysm Registry (STAR)
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.98(2), pp.345-357
- DOI
- 10.1227/neu.0000000000003563
- PMID
- 40488514
- NLM abbreviation
- Neurosurgery
- ISSN
- 1524-4040
- eISSN
- 1524-4040
- Language
- English
- Electronic publication date
- 06/09/2025
- Date published
- 02/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984829882702771
Metrics
8 Record Views