Raffaele Ornello, MD

Rumalla K, Ottenhausen M, Kan P, Burkhardt J-K. Recent Nationwide Impact of Mechanical Thrombectomy on Decompressive Hemicraniectomy for Acute Ischemic Stroke. Stroke. 2019;50:2133–2139

Decompressive hemicraniectomy (DHC) is performed to treat malignant cerebral edema (MCE), a potentially devastating consequence of ischemic stroke. It has been hypothesized that mechanical thrombectomy (MT) procedure might prevent the need of MCE in patients with the most severe forms of ischemic stroke by restoring the blood flow in the ischemic penumbra.

To verify that hypothesis, the authors of the present study reviewed the National Inpatient Sample, a large United States dataset of hospitalized patients, to assess the trends of DHC and MT from 2012 to 2016, the years in which there was a massive implementation of MT. The study showed that the increase of MT procedure was paralleled by a sharp decrease in the number of DHCs, that was more evident after 2015, when the MT guidelines were published. Data also showed that patients undergoing MT were less likely to undergo DHC.

Those data are relevant, as they suggest that MT, a procedure with a largely favorable impact on ischemic stroke-related disability, also prevents the need for DHC, a potentially life-saving procedure with a limited impact on disability. The increasing number of MT will likely increase the load of activity of comprehensive stroke centers; however, data suggest it is worth the effort.