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Comparison and Validation of Diagnostic Criteria of Malignant Middle Cerebral Artery Infarction.

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Title: Comparison and Validation of Diagnostic Criteria of Malignant Middle Cerebral Artery Infarction.
Authors: Liu, Meng (AUTHOR), Wang, Yanan (AUTHOR), Hua, Xing (AUTHOR), Huang, Linrui (AUTHOR), Liu, Ming (AUTHOR), Wu, Simiao (AUTHOR), Colosimo, Carlo (AUTHOR)
Source: Acta Neurologica Scandinavica. 11/11/2025, Vol. 2025, p1-16. 16p.
Subjects: Ischemic stroke, Surgical decompression, Cerebral infarction, Evaluation methodology, Functional status, Cohort analysis, Clinical trials, Prognosis
Abstract: Objectives: Malignant middle cerebral artery infarction (mMCAi) is a critical condition. Decompressive hemicraniectomy (DHC) improves survival after mMCAi, but its surgical indications vary across studies. We aimed to compare and validate diagnostic criteria of mMCAi. Methods: In this prospective cohort study, we recruited patients with acute ischemic stroke in the MCA territory. Based on eight diagnostic criteria of mMCAi reported in randomized trials of DHC, we examined their agreement in diagnosing mMCAi by these criteria and explored their prognostic value on 3‐month death. In patients meeting any of these criteria, we investigated the association of DHC with functional outcomes (assessed by modified Rankin scale, mRS). We proposed an operational definition of mMCAi. Results: We included 1290 patients with MCA infarction (mean age 68.2 years, 58.2% men), with an incidence of mMCAi ranging from 4.4% to 20.9%. All criteria but HeADDFIRST reached substantial to almost perfect agreement with each other in diagnosing mMCAi (Cohen′s kappa ranging from 0.64 to 0.92). Three‐month death rates of patients with mMCAi ranged from 42.3% to 73.2%, with hazard ratios of death ranging from 3.79 to 5.65. DHC improved the overall distribution of mRS scores and reduced the risk of death at 3 months in patients who met any criteria of DESTINY, HAMLET, DESTINY II, or HeADDFIRST. Patients who met either HAMLET or DESTINY II criteria had comparable incidence (around 12%, Cohen′s kappa 0.92) and 3‐month case fatality (around 60%). Based on these two criteria, we proposed an operational definition for mMCAi, which identified 14.0% of patients with mMCAi who benefited from DHC on reducing 3‐month death (OR 0.35, 95% CI 0.12–0.97) and improving mRS distribution (common OR 2.62, 95% CI 1.02–6.71). Conclusion: Patients with MCA infarction who met HAMLET or DESTINY II criteria had a relatively high incidence and case fatality, and both benefited from DHC. Trial Registration: ClinicalTrials.gov identifier: NCT03222024 [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Comparison and Validation of Diagnostic Criteria of Malignant Middle Cerebral Artery Infarction.
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  Label: Authors
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  Data: <searchLink fieldCode="AR" term="%22Liu%2C+Meng%22">Liu, Meng</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wang%2C+Yanan%22">Wang, Yanan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hua%2C+Xing%22">Hua, Xing</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Huang%2C+Linrui%22">Huang, Linrui</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Liu%2C+Ming%22">Liu, Ming</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wu%2C+Simiao%22">Wu, Simiao</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Colosimo%2C+Carlo%22">Colosimo, Carlo</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Acta+Neurologica+Scandinavica%22">Acta Neurologica Scandinavica</searchLink>. 11/11/2025, Vol. 2025, p1-16. 16p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Ischemic+stroke%22">Ischemic stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+decompression%22">Surgical decompression</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebral+infarction%22">Cerebral infarction</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+methodology%22">Evaluation methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Functional+status%22">Functional status</searchLink><br /><searchLink fieldCode="DE" term="%22Cohort+analysis%22">Cohort analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+trials%22">Clinical trials</searchLink><br /><searchLink fieldCode="DE" term="%22Prognosis%22">Prognosis</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: Malignant middle cerebral artery infarction (mMCAi) is a critical condition. Decompressive hemicraniectomy (DHC) improves survival after mMCAi, but its surgical indications vary across studies. We aimed to compare and validate diagnostic criteria of mMCAi. Methods: In this prospective cohort study, we recruited patients with acute ischemic stroke in the MCA territory. Based on eight diagnostic criteria of mMCAi reported in randomized trials of DHC, we examined their agreement in diagnosing mMCAi by these criteria and explored their prognostic value on 3‐month death. In patients meeting any of these criteria, we investigated the association of DHC with functional outcomes (assessed by modified Rankin scale, mRS). We proposed an operational definition of mMCAi. Results: We included 1290 patients with MCA infarction (mean age 68.2 years, 58.2% men), with an incidence of mMCAi ranging from 4.4% to 20.9%. All criteria but HeADDFIRST reached substantial to almost perfect agreement with each other in diagnosing mMCAi (Cohen′s kappa ranging from 0.64 to 0.92). Three‐month death rates of patients with mMCAi ranged from 42.3% to 73.2%, with hazard ratios of death ranging from 3.79 to 5.65. DHC improved the overall distribution of mRS scores and reduced the risk of death at 3 months in patients who met any criteria of DESTINY, HAMLET, DESTINY II, or HeADDFIRST. Patients who met either HAMLET or DESTINY II criteria had comparable incidence (around 12%, Cohen′s kappa 0.92) and 3‐month case fatality (around 60%). Based on these two criteria, we proposed an operational definition for mMCAi, which identified 14.0% of patients with mMCAi who benefited from DHC on reducing 3‐month death (OR 0.35, 95% CI 0.12–0.97) and improving mRS distribution (common OR 2.62, 95% CI 1.02–6.71). Conclusion: Patients with MCA infarction who met HAMLET or DESTINY II criteria had a relatively high incidence and case fatality, and both benefited from DHC. Trial Registration: ClinicalTrials.gov identifier: NCT03222024 [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1155/ane/9938771
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      – Code: eng
        Text: English
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        PageCount: 16
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    Subjects:
      – SubjectFull: Ischemic stroke
        Type: general
      – SubjectFull: Surgical decompression
        Type: general
      – SubjectFull: Cerebral infarction
        Type: general
      – SubjectFull: Evaluation methodology
        Type: general
      – SubjectFull: Functional status
        Type: general
      – SubjectFull: Cohort analysis
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      – SubjectFull: Clinical trials
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      – SubjectFull: Prognosis
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    Titles:
      – TitleFull: Comparison and Validation of Diagnostic Criteria of Malignant Middle Cerebral Artery Infarction.
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            NameFull: Liu, Meng
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              Text: 11/11/2025
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              Y: 2025
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