Effect of Decompressive Craniectomy According to Location of Deep Intracerebral Hemorrhage: A SWITCH Trial Analysis
Year: 2025
Type: article
Abstract: BACKGROUND: Decompressive craniectomy (DC) seemed to reduce the risk of death or profound disability (modified Rankin Scale score, 5–6) after deep intracerebral hemorrhage (ICH) by an absolute 13% (95% CI, 0%–26%) in the SWITCH trial (Swiss Trial of Decompressive Craniectomy versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage). Whether the effect of DC differs by ICH location is unknown. METHODS: Post hoc analysis of participants with supratentorial severe deep ICH from the intention-to-treat population of the SWITCH randomized controlled trial. We categorized ICH as involving (1) the basal ganglia (BG) alone, (2) BG and the posterior limb of the internal capsule (PLIC), or (3) BG, PLIC, and thalamus. We examined the interaction between ICH location and DC’s effect on primary (modified Rankin Scale score, 5–6) and secondary outcomes (death; full modified Rankin Scale score range) at 180 days using unadjusted and adjusted logistic or survival models. RESULTS: Of 197 participants comprising the trial’s intention-to-treat population, 184 were available for analysis (median age, 61 years; 59 women; 91 randomized to DC plus best medical treatment; and 93 to best medical treatment). ICH involved BG alone in 26 (14%), BG+PLIC in 94 (51%), and BG+PLIC+thalamus in 64 participants (35%). The marginal risk of the primary outcome after adjustment for age, ICH severity, and volume was lower with DC by 15.6% (95% CI, −49.2% to 18.1%) in participants with ICH of BG alone, by 11.4% (−29.3% to 6.6%) in those with ICH of BG+PLIC, and by 9% (−31% to 12.9%) in those with ICH of BG+PLIC+thalamus, without evidence for treatment-by-location interaction ( P =0.95). Secondary outcome analyses yielded consistent results. CONCLUSIONS: The potential benefits of DC seemed preserved regardless of the location of severe deep ICH. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02258919.
Source: Stroke
Authors: Alexandros A. Polymeris, Matthias F. Lang, Arsany Hakim, Lukas Bütikofer, Christian Fung, Seraina Beyeler, Werner Z’Graggen, Daniel Strbian, Peter Vajkoczy, Gerrit A. Schubert, Andreas Gruber, Dorothee Mielke, Roland Roelz, Bernhard Siepen, David J. Seiffge, Magdy H. Selim, Andreas Raabe, Jürgen Beck, Urs Fischer, on behalf of the SWITCH Study Investigators
Institutions: Beth Israel Deaconess Medical Center, Harvard University, University of Basel, University Hospital of Basel, University of Bern, University Hospital of Bern, University of Freiburg, University Medical Center Freiburg, University of Helsinki, Helsinki University Hospital, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Universitätsklinikum Aachen, Kantonsspital Aarau, RWTH Aachen University, Johannes Kepler University of Linz, Kepler Universitätsklinikum, University Hospital Augsburg, Universitätsmedizin Göttingen, University of Göttingen
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4415300920