Decompressive craniectomy for deep intracerebral haemorrhage: a SWITCH towards better outcomes?

Stroke is the second leading cause of death and the third leading cause of disability-adjusted life-years (DALYs) lost globally. 1 Collaborators GBDSGlobal, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20: 795-820 Summary Full Text Full Text PDF PubMed Scopus (1997) Google Scholar Close to 30% of strokes are haemorrhagic, with intracerebral haemorrhage affecting 3·4 million people worldwide. 1 Collaborators GBDSGlobal, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20: 795-820 Summary Full Text Full Text PDF PubMed Scopus (1997) Google Scholar Despite being less common than ischaemic stroke, the DALYs lost as a result of haemorrhagic stroke exceed those after ischaemic stroke. 1 Collaborators GBDSGlobal, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20: 795-820 Summary Full Text Full Text PDF PubMed Scopus (1997) Google Scholar Current proven treatment options are limited to applying an acute care bundle, 2 Ma L Hu X Song L et al. The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial. Lancet. 2023; 402: 27-40 Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar including treatment of high blood pressure and stroke unit care. 3 Langhorne P Fearon P Ronning OM et al. Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis. Stroke. 2013; 44: 3044-3049 Crossref PubMed Scopus (122) Google Scholar Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trialSWITCH provides weak evidence that decompressive craniectomy plus best medical treatment might be superior to best medical treatment alone in people with severe deep intracerebral haemorrhage. The results do not apply to intracerebral haemorrhage in other locations, and survival is associated with severe disability in both groups. Full-Text PDF Open Access