Background: Malignant ischemic stroke is a known cerebrovascular complication in patients with SARS-CoV-2 infection, and decompressive craniectomy has been proposed as a treatment option. However, there is limited data available on the outcomes of patients with malignant stroke and concurrent SARS-CoV-2 infection. This study aimed to investigate whether decompressive craniectomy is beneficial for patients with malignant stroke and SARS-CoV-2 infection. Methods: This case-control study was conducted between March 2020 and December 2021, involving patients diagnosed with malignant stroke who underwent decompressive craniectomy. A total of 52 patients were included and divided into two groups: Group 1 consisted of patients with malignant ischemic stroke and concurrent SARS-CoV-2 infection (n = 20), while Group 2 comprised patients with malignant ischemic stroke without SARS-CoV-2 infection (n = 32). Medical data were collected for analysis. Results: The data analysis included variables such as diagnosis of COVID-19 and clinical outcome of death. Statistical tests, including the Chi-squared test with Yates’s correction (p = 0.9094), Fischer’s Exact Test (p = 0.7708), Coefficient φ (0.0568), and Odds Ratio (1.273, 95% CI: 0.4332 - 4.343), were conducted using a contingency table. The results showed no significant association between SARS-CoV-2 infection and the clinical outcome of death. Conclusion: The findings indicate that patients with SARS-CoV-2 infection benefit from decompressive craniectomy for the treatment of malignant stroke to the same extent as patients without viral infection. This study provides valuable insights into the efficacy in patients with malignant stroke and SARS-CoV-2 infection. Further research is warranted to confirm these findings and explore additional factors that may influence patient outcomes in this context.
References
[1]
Aghayari Sheikh Neshin, S., Shahjouei, S., Koza, E., Friedenberg, I., Khodadadi, F., Sabra, M. et al. (2021). Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology. Frontiers in Cardiovascular Medicine, 8, Article ID: 649922. https://doi.org/10.3389/fcvm.2021.649922
[2]
Alkhaibary, A., Abbas, M., Ahmed, M. E., Khatri, I. A., & Alkhani, A. (2020). Common Carotid Artery Occlusion in a Young Patient: Can Large-Vessel Stroke Be the Initial Clinical Manifestation of Coronavirus Disease 2019? World Neurosurgery, 144, 140-142. https://doi.org/10.1016/j.wneu.2020.08.154
[3]
Almqvist, J., Granberg, T., Tzortzakakis, A., Klironomos, S., Kollia, E., Öhberg, C. et al. (2020). Neurological Manifestations of Coronavirus Infections—A Systematic Review. Annals of Clinical and Translational Neurology, 7, 2057-2071. https://doi.org/10.1002/acn3.51166
[4]
Bhatia, R., Padma Srivastava, M. V., Sylaja, P. N., Komakula, S., Upadhyay, A., Pardasani, V. et al. (2021). Clinical Features and Outcome of Stroke with COVID-19. COVID-19 Stroke Study Group (CSSG), India. Annals of Indian Academy of Neurology, 24, 668-685. https://doi.org/10.4103/aian.AIAN_122_21
[5]
Chan, K. I. P., Salonga, A. E. M., Khu, K. J. O. et al. (2021). Decompressive Hemicraniectomy for Acute Ischemic Stroke Associated with Coronavirus Disease 2019 Infection: Case Report and Systematic Review. Surgical Neurology International, 12, 116. https://doi.org/10.25259/SNI_64_2021
[6]
De Macêdo Filho, L. J. M., Aragão, A. C. A., Dos Santos, V. T. D., Galvão, L. B. A., Shlobin, N. A., De Biase, G. et al. (2021). Impact of COVID-19 on Neurosurgery in Brazil’s Health System: The Reality of a Developing Country Affected by the Pandemic. World Neurosurgery, 155, e142-e149. https://doi.org/10.1016/j.wneu.2021.08.030
[7]
Dominguez, S. R., Robinson, C. C., & Holmes, K. V. (2009). Detection of Four Human Coronaviruses in Respiratory Infections in Children: A One-Year Study in Colorado. Journal of Medical Virology, 81, 1597-1604. https://doi.org/10.1002/jmv.21541
[8]
Du, Y., Tu, L., Zhu, P., Mu, M., Wang, R., Yang, P. et al. (2020). Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. American Journal of Respiratory and Critical Care Medicine, 201, 1372-1379. https://doi.org/10.1164/rccm.202003-0543OC
[9]
Ellul, M. A., Benjamin, L., Singh, B., Lant, S., Michael, B. D., Easton, A. et al. (2020). Neurological Associations of COVID-19. The Lancet Neurology, 19, 767-783. https://doi.org/10.1016/S1474-4422(20)30221-0
[10]
Goedemans, T., Verbaan, D., Coert, B. A., Kerklaan, B., van den Berg, R., Coutinho, J. M. et al. (2020). Outcome after Decompressive Craniectomy for Middle Cerebral Artery Infarction: Timing of the Intervention. Neurosurgery, 86, E318-E325. https://doi.org/10.1093/neuros/nyz522
[11]
Habas, K., Nganwuchu, C., Shahzad, F., Gopalan, R., Haque, M., Rahman, S., Majumder, A. A., & Nasim, T. (2020). Resolution of Coronavirus Disease 2019 (COVID-19). Expert Review of Anti-Infective Therapy, 18, 1201-1211. https://doi.org/10.1080/14787210.2020.1797487
[12]
Hofmeijer, J., Kappelle, L. J., Algra, A., Amelink, G. J., van Gijn, J., van der Worp, H. B., & HAMLET Investigators (2009). 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. The Lancet Neurology, 8, 326-333. https://doi.org/10.1016/S1474-4422(09)70047-X
[13]
Jüttler, E., Bösel, J., Amiri, H., Schiller, P., Limprecht, R., Hacke, W., Unterberg, A., & DESTINY II Study Group (2011). DESTINY II: Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery II. International Journal of Stroke, 6, 79-86. https://doi.org/10.1111/j.1747-4949.2010.00544.x
[14]
Jüttler, E., Schwab, S., Schmiedek, P., Unterberg, A., Hennerici, M., Woitzik, J., Witte, S., Jenetzky, E., Hacke, W., & DESTINY Study Group (2007). Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): A Randomized, Controlled Trial. Stroke, 38, 2518-2525. https://doi.org/10.1161/STROKEAHA.107.485649
[15]
Kananeh, M. F., Thomas, T., Sharma, K., Herpich, F., Urtecho, J., Athar, M. K., Jabbour, P., & Shah, S. O. (2020). Arterial and Venous Strokes in the Setting of COVID-19. Journal of Clinical Neuroscience, 79, 60-66. https://doi.org/10.1016/j.jocn.2020.07.005
[16]
Khalafallah, A. M., Jimenez, A. E., Lee, R. P., Weingart, J. D., Theodore, N., Cohen, A. R. et al. (2020). Impact of COVID-19 on an Academic Neurosurgery Department: The Johns Hopkins Experience. World Neurosurgery, 139, e877-e884. https://doi.org/10.1016/j.wneu.2020.05.167
[17]
Liang, J. W., Reynolds, A. S., Reilly, K. et al. (2020). COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke. Stroke, 51, e215-e218. https://doi.org/10.1161/STROKEAHA.120.030804
[18]
Najjar, S., Najjar, A., Chong, D. J., Pramanik, B. K., Kirsch, C., Kuzniecky, R. I., Pacia, S. V., & Azhar, S. (2020). Central Nervous System Complications Associated with SARS-CoV-2 Infection: Integrative Concepts of Pathophysiology and Case Reports. Journal of Neuroinflammation, 17, Article No. 231. https://doi.org/10.1186/s12974-020-01896-0
[19]
Oxley, T. J., Mocco, J., Majidi, S., Kellner, C. P., Shoirah, H., Singh, I. P. et al. (2020). Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. The New England Journal of Medicine, 382, e60. https://doi.org/10.1056/NEJMc2009787
[20]
Patel, H. N., Syed, A., Lobel, J. S., Galler, R., Georges, J., Carmody, M., & Puumala, M. (2020). Cerebellar Infarction Requiring Surgical Decompression in Patient with COVID-19 Pathological Analysis and Brief Review. Interdisciplinary Neurosurgery, 22, Article ID: 100850. https://doi.org/10.1016/j.inat.2020.100850
[21]
Patel, S. D., Kollar, R., Troy, P., Song, X., Khaled, M., Parra, A., & Pervez, M. (2020). Malignant Cerebral Ischemia in a COVID-19 Infected Patient: Case Review and Histopathological Findings. Journal of Stroke and Cerebrovascular Diseases, 29, Article ID: 105231. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105231
[22]
Pisano, T. J., Hakkinen, I., & Rybinnik, I. (2020). Large Vessel Occlusion Secondary to COVID-19 Hypercoagulability in a Young Patient: A Case Report and Literature Review. Journal of Stroke and Cerebrovascular Diseases, 29, Article ID: 105307. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105307
[23]
Rascón-Ramirez, F. J., Carrascosa-Granada, á. M., Vargas-Jiménez, A. C., Ferrández- Pujante, B., & Ortuño-Andériz, F. (2020). Supra and Infratentorial Massive Strokes in Previously Healthy Young Patients with SARS-CoV-2. The Role of Neurosurgery. Neurocirugia, 32, 194-198. https://doi.org/10.1016/j.neucir.2020.08.001
[24]
Romero-Sánchez, C. M., Díaz-Maroto, I., Fernández-Díaz, E., Sánchez-Larsen, á., Layos-Romero, A., García-García, J. et al. (2020). Neurologic Manifestations in Hospitalized Patients with COVID-19: The ALBACOVID Registry. Neurology, 95, e1060-e1070. https://doi.org/10.1212/WNL.0000000000009937
[25]
Roy, D., Hollingworth, M., & Kumaria, A. (2021). A Case of Malignant Cerebral Infarction Associated with COVID-19 Infection. British Journal of Neurosurgery, 35, 191-194. https://doi.org/10.1080/02688697.2020.1779180
[26]
Sáez-Alegre, M., García-Feijoo, P., Millán, P., Vivancos Sánchez, C., Rodríguez Domínguez, V., García Nerín, J., Isla Guerrero, A., & Gandía-González, M. L. (2021). Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option? Frontiers in Neurology, 12, Article ID: 632036. https://doi.org/10.3389/fneur.2021.632036
[27]
Scala, M. R., Spennato, P., Cicala, D., Piccolo, V., Varone, A., & Cinalli, G. (2021). Malignant Cerebral Infarction Associated with COVID-19 in a Child. Child’s Nervous System, 38, 441-445. https://doi.org/10.1007/s00381-021-05273-x
[28]
Shi, Y., Wang, G., Cai, X. P., Deng, J. W., Zheng, L., Zhu, H. H., Zheng, M., Yang, B., & Chen, Z. (2020). An Overview of COVID-19. Journal of Zhejiang University Science B, 21, 343-360. https://doi.org/10.1631/jzus.B2000083
[29]
Sudheer, P., Gomathy, S. B., Agarwal, A. et al. (2022). Effect of Decompression Craniectomy on Survival and Functional Outcome in Patients with COVID-19 and Malignant Infarct: A Retrospective Cohort Study and Review of Literature. Journal of Stroke Medicine, 5, 48-55. https://doi.org/10.1177/25166085221098914
[30]
Vahedi, K., Vicaut, E., Mateo, J., Kurtz, A., Orabi, M., Guichard, J. P. et al. (2007). Sequential-Design, Multicenter, Randomized, Controlled Trial of Early Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction (DECIMAL Trial). Stroke, 38, 2506-2517. https://doi.org/10.1161/STROKEAHA.107.485235
[31]
Zoia, C., Bongetta, D., Veiceschi, P., Cenzato, M., Di Meco, F., Locatelli, D., Boeris, D., & Fontanella, M. M. (2020). Neurosurgery during the COVID-19 Pandemic: Update from Lombardy, Northern Italy. Acta Neurochirurgica (Wien), 162, 1221-1222. https://doi.org/10.1007/s00701-020-04305-w
