A 70-year-old woman presents with acute right hemiplegia and global aphasia. Non-contrast CT shows a large left MCA territory infarct involving more than two-thirds of the MCA territory with midline shift. She is 50 years old in clinical trial terms but actually 70. According to pooled European trial data, decompressive hemicraniectomy within 48 hours in patients aged 18-60 years with malignant MCA infarction significantly reduces mortality. What is the number needed to treat (NNT) for survival at 12 months in this context?

• A NNT of 12 for survival
• B NNT of 4 for survival
• C NNT of 8 for survival
• D NNT of 2 for survival ✓

Explanation

The pooled analysis of DECIMAL, DESTINY, and HAMLET trials showed that decompressive hemicraniectomy within 48 hours for malignant MCA infarction in patients up to 60 years reduced mortality from 70% to approximately 20%, giving an NNT of about 2 to save one life. Functional outcomes also improved, though some survivors had moderate disability. These trials established surgery as standard of care for this condition within the age and time window.

Reference: Stroke (AHA/ASA Guidelines) and pooled trial data, 2014 AHA/ASA Early Management of Acute Ischemic Stroke ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.