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Observational Study
. 2025 Mar 4;15(1):7600.
doi: 10.1038/s41598-025-92284-2.

The malignant stroke indicator is an early indicator of malignant ischemic stroke requiring decompressive hemicraniectomy

Xenia Hautmann  1   2 , Ala Jamous  3 , Ilko Maier  4 , Christoph Bettag  1 , Silvia Hernandez Duran  1 , Ruslan Muradzade  1 , Dorothee Mielke  1   2 , Veit Rohde  1 , Vesna Malinova  5
Affiliations
Observational Study

The malignant stroke indicator is an early indicator of malignant ischemic stroke requiring decompressive hemicraniectomy

Xenia Hautmann et al. Sci Rep. .

Abstract

Decompressive craniectomy (DHC) can prevent mortality in patients with malignant ischemic stroke. However, no clear criteria have been established to early identify patients, who will develop malignant stroke requiring DHC. In this retrospective observational study, a large patient cohort with ischemic stroke treated between 2010 and 2021, was analyzed. Clinical and radiological parameters were analyzed. Univariate and multivariate regression analyses were performed to identify the parameters to be included in the score. A cohort of 534 patients was included. A malignant stroke indicator (MSI) score was created including age < 70 years with 7 points, midline shift with up to 6 points, unsuccessful recanalization (TICI < 2b) with 6 points, basal cistern effacement with 4 points, and CBV ASPECTS < 6 with 3 points assigned. A MSI score with a cutoff value of 9 showed a high discrimination power concerning the need for DHC (AUC 0.90, p < 0.0001). Patients with MSI-score ≥ 9 had a 22-fold higher probability of needing DHC (odds ratio 22.90, p < 0.0001). The MSI score is a promising tool to predict the need for DHC in patients at risk for developing a malignant stroke and needs to be validated in external cohorts.

Keywords: Brain edema; Decompressive hemicraniectomy; Malignant ischemic stroke.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was performed in line with the principles of the 1964 Helsinki declaration and its later amendments. This is an observational study. The study was approved by the Ethics Committee of the University Medical Center Göttingen (Number 6/10/23).

Figures

Fig. 1
Fig. 1
ROC-analysis of the MSI-score for the discrimination of patients requiring DHC and those, who don’t (AUC 0.90, 95%CI 0.87–0.93; p < 0.0001) with a cutoff value of ≤ 9 points.
Fig. 2
Fig. 2
Patients with MSI-score of ≥ 9 had a 22-fold higher probability of requiring decompressive hemicraniectomy compared to those with MSI-score < 9 (Fisher’s Exact test, OR 22.90, 95%CI 14.08 to 37.48 sensitivity 69%, 95%CI 62–76%; specificity 91%, 95%CI 88–94%; positive predictive value 79%, 95%CI 72–85%; negative predictive value 86%, 95%CI 82–89%; p < 0.0001).
See this image and copyright information in PMC

References

    1. Hacke, W. et al. Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch. Neurol.53(4), 309–315. 10.1001/archneur.1996.00550040037012 (1996). - PubMed
    1. Hecht, N. et al. Infarct volume predicts outcome after decompressive hemicraniectomy for malignant hemispheric stroke. J. Cereb. Blood Flow. Metab.38(6), 1096–1103. 10.1177/0271678x17718693 (2018). - PMC - PubMed
    1. Jüttler, E. et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl. J. Med.20(12), 1091–1100. 10.1056/NEJMoa1311367 (2014). - PubMed
    1. Neugebauer, H. & Jüttler, E. Hemicraniectomy for malignant middle cerebral artery infarction: current status and future directions. Int. J. Stroke9(4), 460–467. 10.1111/ijs.12211 (2014). - PubMed
    1. Vahedi, K. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: A pooled analysis of three randomised controlled trials. Lancet Neurol.6(3), 215–222. 10.1016/s1474-4422(07)70036-4 (2007). - PubMed

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