Hemicraniectomy for Malignant Middle Cerebral Artery Infarction (HeMMI)
Hemicraniectomy for Malignant Middle Cerebral Artery Infarction (HeMMI)
A single-centered, randomized, controlled clinical trial comparing standardized medical care
 alone with standardized medical care and decompressive hemicraniectomy to determine the
 effectiveness of decompressive surgery more definitively in patients with clinical signs of
 infarction of the Middle Carotid Artery (MCA) territory.
A single-centered, randomized, controlled clinical trial comparing standardized medical care
 alone with standardized medical care and decompressive hemicraniectomy to determine the
 effectiveness of decompressive surgery more definitively in patients with clinical signs of
 infarction of the MCA territory and and who arrived at the hospital within 72 hours of
 symptom onset.
Inclusion Criteria:

 -  Patients between 18 to 65 years old who presented with clinical signs of infarction of
 the MCA territory and who arrived at the hospital within 72 hours of symptom onset.
 Other inclusion criteria included a Glasgow coma score (GCS) of 6 to14 in patients
 with right MCA infarction or GCS 5 to 9 in patients with left MCA infarction (adjusted
 to account for effect on speech deficit on GCS scores), or GCS of 15 on arrival but
 subsequently deteriorated neurologically as defined by a score of ≥1 on the level of
 consciousness item of the National Institutes of Health Stroke Scale (NIHSS);computed
 tomography (CT) scan of the head showing ischemic changes corresponding to more than
 50% of the MCA territory with or without involvement of other vascular territories;and
 written informed consent from the patient or a legal representative.

 Exclusion Criteria:

 -  Patients with previous disabling neurological disease, an estimated premorbid modified
 Rankin Scale (mRS) score >2; terminal illness; presence of serious medical
 comorbidities like end-stage renal failure and cardiac disease with severe hemodynamic
 compromise; infarction due to surgical complications or vasospasm; primary
 intracranial hemorrhage; coagulopathies; and high risk for surgery upon assessment by
 the medical team.