• European neurology · Jan 2012

    Randomized Controlled Trial

    Decompressive surgery for malignant middle cerebral artery infarcts: the results of randomized trials can be reproduced in daily practice.

    • Christian Lucas, Laurent Thines, Frédéric Dumont, Xavier Leclerc, Bernard Riegel, Charlotte Cordonnier, François Fourrier, Hilde Hénon, Marc Rousseaux, Didier Leys, and Jean-Paul Lejeune.
    • Department of Neurology, University Lille Nord de France, Lille, France. christian.lucas@chru-lille.fr
    • Eur. Neurol. 2012 Jan 1; 68 (3): 145-9.

    BackgroundIn clinical randomized controlled trials (RCTs), decompressive surgery (DS) for malignant middle cerebral artery (MMCA) infarcts leads to a 50% absolute risk reduction in mortality, and improves the 1-year functional outcome. The reproducibility of these results in routine practice has never been evaluated. The purpose of this study was to test the hypothesis that the results of DS for MMCA in practice are similar to those observed in the surgical group of RCTs.MethodsWe prospectively included the first 31 patients who underwent DS for MMCA. They were screened based on similar criteria as in the meta-analysis. The primary outcome was a modified Rankin Scale (mRS) score of ≤4, and secondary outcomes were mRS of ≤3 and death at 1 year.ResultsThirty-one patients underwent DS for MMCA. The 1-year mRS was ≤4 in 22 patients (71.0%) and ≤3 in 16 (51.6%). Seven patients died (22.6%).ConclusionThis observational study showed that DS for MMCA in a center without previous experience provides similar results as those obtained in the surgical arm of RCTs.Copyright © 2012 S. Karger AG, Basel.

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