The Effect of Intravenous Thrombolysis on Hemorrhagic Complications after Decompressive Craniectomy in Elderly Patients with Middle Cerebral Artery Infarction

, Tae Jin Kim; , Eun Jung Koh; , Hyunho Choi; , Byong-Cheol Kim; , Seung Yeob Yang; , Keun-Tae Cho

Clinical Article

Journal of Korean Society of Geriatric Neurosurgery 2017;13(2):73-79.
Published online September 30, 2017.

The Effect of Intravenous Thrombolysis on Hemorrhagic Complications after Decompressive Craniectomy in Elderly Patients with Middle Cerebral Artery Infarction

Tae Jin Kim , Eun Jung Koh , Hyunho Choi , Byong-Cheol Kim , Seung Yeob Yang , Keun-Tae Cho

Department of Neurosurgery, Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea

노인 중대뇌동맥 뇌경색 환자에서 정맥 내 혈전용해술이 감압 개두술 후 출혈성 합병증 발생에 미치는 효과에 관한 연구

김태진·고은정·최현호·김병철·양승엽·조근태

동국대학교 의과대학 일산병원 신경외과학교실

Abstract

Objective
The purpose of this study is to evaluate the effect of intravenous thrombolysis on hemorrhagic complications after decompressive craniectomy (DC) in elderly patients with middle cerebral artery (MCA) infarction.
Methods
We retrospectively reviewed the medical record and radiographs of 18 patients who were aged 65 and over, had unilateral MCA infarction, received intravenous thrombolysis, and thereafter underwent DC to control intractable intracranial pressure.
Results
Total 18 patients with ischemic stroke received DC during the study period. Nine patients received intravenous tissue plasminogen activator (tPA) therapy and 9 patients did not. Postoperative epidural hemorrhages occurred in 1 patient in the intravenous tPA group and 3 in the non-tPA group (p=0.576). Postoperative intracerebral hemorrhages occurred in 1 patient and in 2 patients in each groups (p=1.000), and hemorrhagic transformation occurred in 6 and 4 patients in each groups (p=0.637). The extended Glasgow outcome scale at 1, 3, and 6 months after the onset were 2.67±0.37, 2.67±0.41, and 2.67±0.41 in the tPA group, 2.44±0.44, 2.67±0.50, and 2.67±0.50 in the non-tPA group (p=0.253, 0.300, 0.340). The modified Rankin scale at 1, 3, and 6 months after the onset were 4.44±1.13, 4.78±1.30, and 4.78±1.30 in the tPA group, 5.00±1.00, 5.00±1.22, and 5.00±1.22 in the non-tPA group (p=0.286, 0.714, 0.714).
Conclusion
According to this study, preoperative intravenous thrombolysis in elderly patients with ischemic stroke has no effect on the risk of hemorrhagic complications and outcome.

Key Words: Decompressive craniectomy, Tissue plasminogen activator, Middle cerebral artery, Infarction, Hemorrhagic complications