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Background

Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes.

Methods

A retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age.

Results

The final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs 67% vs. 41%; p = 0.039, whose group also had a worse outcome 76% with mRS 5 or 6 at 90 days OR 3.91 CI95% 1.30–11.74, whereas only 24% had mRS of 0–4 p = 0.015. All patients who presented with sepsis died p = 0.003. The incidence of pulmonary infection was very high in the elderly group 76% with significant intergroup differences p = 0.027, OR 8.32 CI95% 0.70–98.48.

Conclusions

Older patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region.



Autor: Roberto Bezerra Vital , Pedro Tadao Hamamoto Filho, Gustavo Jose Luvizutto, Luis Gustavo Ducati, Gabriel Pereira Braga, Helio Rub

Fuente: http://plos.srce.hr/



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