A malignant MCA infarction is defined as a proximal occlusion of the Arteria cerebri media, resulting in a large-volume infarct in the MCA territory. The resulting cerebral edema can progress to herniation, which accounts for the designation malignant infarction.

Imaging

Malignant MCA infarction on CT — Depiction of a left-sided malignant MCA infarction on a noncontrast axial CT image.

Surgical therapy

One therapeutic option is decompressive hemicraniectomy as a therapeutic decompression[^1]. If surgical decompressive therapy is chosen, current evidence shows that rapid surgical decompression within 48 hours results in better outcomes and reduced mortality[^1] [^2] [^3]. This evidence is based on the three randomized trials on this topic: HAMLET Trial[^2], DECIMAL Trial[^1], and DESTINY Trial[^3].

Evidence from studies on malignant MCA infarction — Evidence from studies on decompressive hemicraniectomy in patients with malignant MCA infarction. Figure adapted from the original HAMLET study.