Decompressive Craniectomy for Ischemic Stroke: Effect of Hemorrhagic Transformation on Outcome

Hosam Al-Jehani, Kevin Petrecca, Phillipe Martel, David Sinclair, Denis Sirhan

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background Decompressive hemicraniectomy (DhC) is a life-saving surgical procedure being increasingly employed for malignant middle cerebral artery strokes. We examined the incidence of hemorrhagic transformation following DhC. Methods We retrospectively reviewed the charts and radiological images of patients who underwent DhC for malignant middle cerebral artery strokes. We classified the hemorrhagic events and assessed the short-term 30-day outcome associated with these events. Results A total of 23 DhCs were performed for supratentorial ischemic strokes in 22 patients. There were 16 males and 6 females with an average age of 47 years (21-69 years). Of the 22 patients, 13 (59%) developed a new hemorrhage following DhC. There were 3 mortalities (14%). Of the survivors, 6 (27%) were discharged home with a modified Rankin Scale (mRS) score of 2. The remaining 13 patients (59%) recovered to a degree wherein they were discharged to a rehabilitation center (mRS score 3-4). No patient persisted in a vegetative or semivegetative state (mRS score 5). Conclusions In this study, the rate of hemorrhagic transformation following DhC for ischemic stroke was 59%. This is much higher than that reported in the stroke thrombolysis literature. The presence of any type of new hemorrhagic transformation in this patient population does not appear to alter the natural history of their ischemic strokes in terms of Glasgow outcome scores or destination of disposition.

Original languageEnglish (US)
Pages (from-to)2177-2183
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
StatePublished - Sep 1 2016


  • Malignant middle cerebral artery stroke
  • decompressive craniectomy
  • hemorrhagic transformation
  • intracerebral hemorrhage
  • intracranial pressure monitoring
  • microbleeds
  • reperfusion injury

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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