Right MCA versus Left MCA Large Territories Infarct Decompressive Surgery and Outcomes

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Right MCA versus Left MCA Large Territories Infarct Decompressive Surgery and Outcomes   

            Decompression refers to a surgical process that is carried out to alleviate pain arising from neural impingement. Decompressive surgery is continually becoming a common operation when treating large hemispheric infarction. Large middle cerebral artery (MCA) stroke has the potential of evolving within a malignant space. This increases the rate of mortality to 80% even in the event that the patient undergoes through a maximal medical therapy (Beez et al., 2019). However, early decompressive craniectomy is considered as an effective technique for improving the functional outcome despite the fact that it increases the risk of complication associated with the invasive surgical approach. This paper provides a review of all the case reports and series noted in the last 2 years while documenting the outcome of each. This will document which form of decompressive surgery has a better outcome when it comes to improving the quality of life per patient and per family.

Case Series Review

            Multi-centric randomized control trials as well as case series have provided a depiction of the fact that an early decompressive craniectomy has proven to be effective in reducing the mortality rates and enhancing the life of patients with malignant MCA Infarcts with functional outcomes.

Decompressive Craniectomy (DC) in Malignant MCA Infarction (DECIMAL)

            In the multicenter trial carried out in France, patients aged between 18 and 55 years took part in the study. The primary outcome derived from the study included the fact that patients recorded a favorable functional outcome six months after the invasive process. Additionally, the general mortality rates recorded by the patients after undergoing through the DC process declined. However, the patient survival rate was estimated at 22.2% for patients who opted for a non-surgical means of treatment (Pallesen, Barlinn & Puetz, 2019). DECIMAL is known be effective in reducing the intracranial pressure rates, curbing the mortality rate, and increasing the number of patients who record a favorable outcome.

Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY) 

            The DESTINY trial was carried out in Germany, including patients aged 18 to 60 years. As a result of the anticipated overwhelming benefits of DC when it comes to mortality, the study relied on sequential design to measure the outcome of mortality. The outcome of this case depicted that the rates of patient mortality decreased significantly. Moreover, the survival rate of the patient one year after the process was estimated at 88% in comparison to patients who opted for the conservative therapy (Pallesen, Barlinn & Puetz, 2019). DESTINY is an effective lifesaving procedure known to improve outcome without promoting the development of a severe disability among persons aged 18-60 years.

Hemicraniectomy after Middle Cerebral Artery Infarction with Life-Threatening Edema Trial (HAMLET)

            The HAMLET trial carried out in the Dutch community included patients aged 18-60 years. In this case, the patients were randomized after the onset of their symptoms to include 64 patients. Looking at the outcome of the trial, it is evident that DC did not show any effective functional outcome one year later after the DC process. However, the risk of fatality recorded a negative trend with a good functional outcome being noted. The same study competed in China did not record any significant outcome difference between the DC patient and those who opted for a conservative form of treatment (Pallesen, Barlinn & Puetz, 2019). The fatality rate associated with HAMLET is as high as 80%. Patients who survive the procedure are highly likely to be left with a severe disability.

Hemicraniectomy and Durotomy upon Deterioration from Infarction Related Swelling Trial (HeADDFIRST) 

HeADDFIRST was a case issue focused on gaining information about the best form of treatment between DC and medical care for large hemispheric infarction. The outcome of the study depicted an improved quality of life for the patient who opted for DC due to a significant reduction in the rate of mortality after the surgical process (Pallesen, Barlinn & Puetz, 2019).

DESTINY II

            DESTINY II randomized trial focused on evaluating the impact of the treatment on the patients aged more than 60 years, 6 months after the invasive procedure. The outcome of the study established that the patients recorded a reduced consciousness with imaging evidence revealing that the infarction had spread to more than two-thirds of the middle cerebral artery territory. The patients lacked functional independence and could not walk without proper assistance (Pallesen, Barlinn & Puetz, 2019). DESTINY II also improves the quality of life despite the fact that the potential for disability after the surgical process is intensified.

Hemicraniectomy for Malignant Middle Cerebral Infarction (HeMMI)

            HeMMI studies carried out in the Philippines including patients with middle cerebral artery infarction aged between 18 and 65 recorded instances of secondary deterioration in consciences and the quality of life. However, in extreme cases such as those involving acute myocardial infarction, the surgical process was not carried out due to the associated health risks likely to occur post-surgery (Pallesen, Barlinn & Puetz, 2019). HeMMI is effective as it improves the quality of life as it reduces the fatality rates by up to 75%. Despite this, the procedure increases the chances that the patient will survive and suffer from a moderately severe disability.

Right MCA Infarction Decompressive Surgery and Quality of Life

Right MCA infarction decompressive surgery is associated with improved quality of life. The quality of life improvement is experienced after the process of surgically decompressing the space-occupying MCA infarct is carried out (van Middelaar, Richard, van der Worp, van den Munckhof, Nieuwkerk, Visser, Stam & Nederkoorn, 2015). Notably, a pooled analysis of the randomized controlled trial cases reviewed above provides a depiction of the fact that patients aged between 18 and 60 years who undergo surgical decompression process have recorded a dramatic reduction in the mortality rate in the events when the surgical process is completed 48 hours after suffering a stroke. However, it is evident that patients who rely on Right MCA infarction decompressive surgery for treatment are highly likely to suffer from severe disability. Moreover, patients who survive the surgery are known to have a poor quality of life which physicians consider as unacceptable (van Middelaar et al., 2015). However, this remains to be a controversial issue since studies have only provided room for speculation as the quality of life unacceptability after the surgical process is unknown (van Middelaar et al., 2015). Arguably, despite showing a positive mental health, it is evident that the depression risk is comparable to that of the general population, and hence, ascertaining if the invasive process influences the quality of life remains to be a questionable factor. With the poor quality of life, it is evident that doctors will choose not to operate on the patient even though they find it difficult to speak and move as well as interact with their families.

Right MCA Infarction Decompressive Surgery and Quality of Life

            According to Beez, Munoz-Bendix, Steiger and Beseoglu (2019), an improved quality of life is experienced among patients who undergo Right MCA infarction decompressive surgery as reflected by the reduced mortality rate. Notably, the probability that the patients who undergo through this surgical process will survive increases at a significant rate of up to 80% from 30% (Beez et al., 2019). Moreover, the chances that the patient will suffer from a severe form of disability of the invasive process is reduced, which further increases the survival potential. Notably, the increased quality of life experienced by the patients is associated with the health risk reduction by up to 50% (Beez et al., 2019).

            Therefore, it is evident that right MCA infarction decompressive surgery is preferred since it has a better quality of life outcome experienced by the patients.