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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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General eligibility criteria for three major trials (DECIMAL, DESTINY, HAMLET) evaluating decompressive hemicraniectomy for malignant middle cerebral artery territory infarction

General eligibility criteria for three major trials (DECIMAL, DESTINY, HAMLET) evaluating decompressive hemicraniectomy for malignant middle cerebral artery territory infarction
Inclusion criteria:
  • Age 18 to 60 years*
  • Clinical deficits suggestive of infarction in the territory of the MCA with a NIHSS score ≥16
  • Decrease in the level of consciousness to a score of ≥1 on item 1a of the NIHSS
  • Signs on brain CT of an infarct of ≥50 percent of the MCA territory, with or without additional infarction in the territory of the ipsilateral anterior or posterior cerebral artery, or infarct volume >145 cm3 on diffusion-weighted brain MRI
  • Time from symptom onset to start of surgical decompression <48 hours
  • Written informed consent by the patient or a legal representative
Exclusion criteria:
  • Prestroke mRS score ≥2
  • Both pupils fixed and dilated
  • Contralateral ischemia or other brain lesion that could affect outcome
  • Space-occupying hemorrhagic transformation of the infarct
  • Life expectancy <3 years
  • Other serious illness that could affect outcome
  • Known coagulopathy or systemic bleeding disorder
  • Contraindication for anesthesia
mRS: modified Rankin Scale; MCA: middle cerebral artery; NIHSS: National Institutes of Health Stroke Scale.
* Four other trials included patients over age 60.
Data from:
  1. Vahedi K, Vicaut E, Mateo J, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 2007; 38:2506.
  2. Jüttler E, Schwab S, Schmiedek P, et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 2007; 38:2518.
  3. Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 2009; 8:326.
  4. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6:215.
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