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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Surgical treatment of acute ischemic stroke in the era of endovascular interventions

Chirugische Therapie des akuten ischämischen Schlaganfalls in der Ära der endovaskulären Interventionen

Meeting Abstract

  • presenting/speaker Ararat Minasyan - Klinikum Chemnitz gGmbH, Klinik für Neurochirurgie, Chemnitz, Deutschland
  • Jörg Thalwitzer - Klinikum Chemnitz gGmbH, Institut für Radiologie und Neuroradiologie, Chemnitz, Deutschland
  • Jens Schwarze - Klinikum Chemnitz gGmbH, Klinik für Neurologie, Chemnitz, Deutschland
  • Ralf Steinmeier - Klinikum Chemnitz gGmbH, Klinik für Neurochirurgie, Chemnitz, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV098

doi: 10.3205/20dgnc102, urn:nbn:de:0183-20dgnc1023

Published: June 26, 2020

© 2020 Minasyan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: During the last years a number of randomized trials (MR CLEAN, SWIFT PRIME, REVASCAT, ESCAPE, DEFUSE 3, DAWN) have shown the efficacy and safety of the primary endovascular interventions (EI) in the management of acute ischemic stroke (AIS). On the other hand, the primary decompressive craniectomy (DC) has been shown to be beneficial (HAMLET, DECIMAL, DESTINY I & II) in the treatment of AIS as well. The goal of our study is to reveal the incidence and possible changes in indications of the DC with the growing number of EI in the treatment of AIS.

Methods: We have retrospectively investigated the medical records of total 5297 (969 in 2014, 1079 in 2015, 1190 in 2016, 1101 in 2017, 958 in 2018) patients with primary AIS treated in our neurovascular center during the period of 2014-2018. The EI included catheter aspiration only or in conjunction with mechanical thrombectomy with or without tandem stenting of ICA. DCs have been performed as minimum of 15cm in diameter with consequent patching of dura with autologous or allogenic material and installation of EVD or ICP sensor. We have analyzed the cases with primary DCs (both supra- and infratentorial) as well as DCs secondary to the EI. Statistical analysis was performed by SPSS 20.0.

Results: The number of primary EI was distributed as follows: 23(2,37%) in 2014, 40(3,71%) in 2015, 44(3,70%) in 2016, 75(6,81%) in 2017 and 109(11,38%) in 2018. The number of overall DCs (primary + secondary) was as follows: 10 (1,03%; 1,03% + 0%) in 2014, 13 (1,20 %; 1,02% + 0,19%) in 2015, 11 (0,92%m 076% + 0,17%) in 2016, 11 (1,00%; 0,82% + 0,18%) in 2017 and 13 (1,36%, 1,04%+0,31%) in 2018. The data obtained have shown a significant increase in the number of EI in comparison to the DC (OR=3,22 (1,34-7,77; CI 95%, p=0.009), Figure 1 [Fig. 1]). The number of DCs remained relatively unchanged, though the ratio of primary DCs was significantly decreased (from 100% in 2014 to 77% in 2018, OR=2,22; 0,17-3,22; CI 95%, p=0,045, Figure 2 [Fig. 2]).

Conclusion: Though the number of primary DCs shows a tendency to decrease, the overall number of DCs remains unchanged due to the increasing number of failed EI. Despite the increasing number of EI the role of the DC remains stable in the management of AIS.