Introduction: Large hemispheric infarction occurs in 10% of stroke cases, resulting in progressive cerebral edema and secondary nervous system damage alongside primary brain injury. Decompressive craniectomy (DC) has shown promising outcomes in mitigating mortality and morbidity associated with malignant cerebral edema (MCE). However, the impact of endovascular stroke interventions on MCE and post-DC outcomes remains unclear.

Aim: This study aims to elucidate the effects of mechanical thrombectomy on MCE by analyzing patient outcomes following DC.

Methods: Data were gathered from patients who underwent DC for MCE between 2015 and 2022. Variables included demographic information, comorbidities, time from symptom onset to hospital admission, initial symptoms, stroke severity (assessed via NIHSS and ASPECT scores), revascularization success, occlusion site, time to decompression, duration of intensive care and hospitalization, DC parameters, and functional outcomes (measured by mRS). Statistical analyses included Wilcoxon regression, Spearman’s rank correlation, Mann-Whitney-U tests and logistic regression analysis.

Results: The study encompassed 92 patients, with mechanical thrombectomy performed in 45 cases (48.9%). Although the relative frequency of MCE-related DC cases has decreased annually, absolute numbers have risen. Initial symptom severity (NIHSS) and stroke extent (ASPECT) showed no significant correlation (p=0.9559; p=0.2496), while successful mechanical revascularization correlated significantly with favorable functional outcomes (p=0.041).

Conclusion: Despite a decline in MCE prevalence due to advancements in mechanical thrombectomy, specialized centers are witnessing an increase in DC cases. Successful mechanical thrombectomy significantly improves outcome in MCE. Early hospitalization in a stroke center that also provides neurosurgical care can significantly improve survival and outcome.

Funding: None.