EVALUATION OF OUTCOME OF CONSERVATIVE TREATMENT IN PATIENTS WITH MASSIVE ISCHEMIC STROKE WHO HAVE NOT UNDERGONE CRANIECTOMY SURGERY

Background & Aims: Decompressive Craniectomy (DC) is recommended for patients with extensive cerebral infarction. At this study, we aimed to assess the mortality and 3-month outcome of these patients who are not going under DC. Material & Methods: In this prospective descriptive study, all patients referred to Imam Reza Hospital in Urmia, Iran, from 2017-2019 with extensive ischemic stroke with refractory medical edema of the brain who did not undergo surgery were included. Patient’s demographic and other brain stroke-related data were recorded. Patients were evaluated for the improvement of brain stroke symptoms based on the comparison of National Institutes of Health Stroke Scale (NIHSS) criteria at the time of hospitalization with discharge time and also for the degree of disability and mortality at three months follow-up according to mRS criteria. P values less than 0.05 were considered statistically significant. Results: A total of 28 patients were enrolled in the study. Median age was 76 years. NIHSS score was 21 at admission and 18 at discharge (p<0.05). Of all 28 patient, 22 (78.6%) died during hospital admission and 24 (85.7%) died up to 3 month follow up. None of the 4 survived patients had a good and independent outcome along the 3-month follow-up (MRS<3). Conclusion: Results of this study showed that in patients with extensive cerebral infarction with edema resistant to medical treatment, fail to perform decompressive craniectomy is associated with a very high mortality rate and poor prognosis.