{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T16:58:21Z","timestamp":1784912301127,"version":"3.55.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial (HeADDFIRST) was a randomized pilot study to obtain information necessary to design a Phase III trial to evaluate the benefit of surgical decompression for brain swelling from large supratentorial cerebral hemispheric infarction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>All patients with stroke were screened for eligibility (age 18\u201375 years, National Institutes of Health Stroke Scale \u226518 with Item 1a&lt;2 [responsive to minor stimulation], and CT demonstrating unilateral, complete middle cerebral artery territory infarction by specific imaging criteria). All enrolled patients were treated using a standardized medical treatment protocol. Those with both \u22654 mm of pineal shift and deterioration in level of arousal or \u22657.5 mm of anteroseptal shift within 96 hours of stroke onset were randomized to continued medical treatment only or medical treatment plus surgery. Death at 21 days was the primary outcome measure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Among 4909 screened patients, only 66 (1.3%) patients were eligible for HeADDFIRST. Forty patients were enrolled, and 26 patients developed the requisite brain swelling for randomization. All who failed to meet randomization criteria were alive at 21 days. Mortality at 21 and 180 days was 40% (4\/10) in the medical treatment only and 21% (3\/14) and 36% (5\/14) in the medical treatment plus surgery arms, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>HeADDFIRST randomization criteria effectively distinguished low from high risk of death from large supratentorial cerebral hemispheric infarction. Lower mortality in the medical treatment only group than in other published trials suggests a possible benefit to standardizing medical management. These results can inform the interpretation of recently completed European trials concerning patient selection and medical management.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>This trial was not registered because enrollment began before July 1, 2005.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.113.003200","type":"journal-article","created":{"date-parts":[[2014,1,15]],"date-time":"2014-01-15T06:02:22Z","timestamp":1389765742000},"page":"781-787","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":136,"title":["Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial"],"prefix":"10.1161","volume":"45","author":[{"given":"Jeffrey I.","family":"Frank","sequence":"first","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Philip","family":"Schumm","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Wroblewski","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Chyatte","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel J.","family":"Rosengart","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christi","family":"Kordeck","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald A.","family":"Thisted","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.I.F., C.K.), Health Studies (L.P.S., K.W., R.A.T.), Statistics (R.A.T.), Anesthesia and Critical Care (R.A.T.), The University of Chicago, IL; Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, MN (D.C.); and Department of Neurology, Weill Cornell Medical College, New York (A.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"HeADDFIRST Trialists","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Gary","family":"Bernardini","sequence":"additional","affiliation":[{"name":"Albany Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"John","family":"Andrefsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Derk","family":"Krieger","sequence":"additional","affiliation":[{"name":"The Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Mitchell","family":"Elkind","sequence":"additional","affiliation":[{"name":"Columbia-Presbyterian Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"William","family":"Coplin","sequence":"additional","affiliation":[{"name":"Detroit Receiving Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Carmelo","family":"Graffagnino","sequence":"additional","affiliation":[{"name":"Duke University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Jose","family":"Biller","sequence":"additional","affiliation":[{"name":"Indiana University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"David","family":"Wang","sequence":"additional","affiliation":[{"name":"OSF Saint Francis Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Salvador","family":"Cruz-Flores","sequence":"additional","affiliation":[{"name":"St. Louis University Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"David","family":"Brock","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Andrew","family":"Demchuk","sequence":"additional","affiliation":[{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Piero","family":"Verro","sequence":"additional","affiliation":[{"name":"University of California Davis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Jeffrey","family":"Frank","sequence":"additional","affiliation":[{"name":"University of Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Daniel","family":"Woo","sequence":"additional","affiliation":[{"name":"University of Cincinnati"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Jose","family":"Suarez","sequence":"additional","affiliation":[{"name":"University Hospitals of Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Creed","family":"Pettigrew","sequence":"additional","affiliation":[{"name":"University of Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Dr","given":"Marian","family":"LaMonte","sequence":"additional","affiliation":[{"name":"University of Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1996.00550040037012"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.7.1286"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70047-X"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.107.485649"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.107.485235"},{"key":"e_1_3_4_7_2","first-page":"9","article-title":"Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk.","volume":"15","author":"von Kummer R","year":"1994","unstructured":"von Kummer R, Meyding-Lamad\u00e9 U, Forsting M, Rosin L, Rieke K, Hacke W, et al.. 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