BACKGROUND AND PURPOSE: We assessed whether the effects of surgical 
decompression for space-occupying hemispheric infarction, observed at 1 year, 
are sustained at 3 years.
METHODS: Patients with space-occupying hemispheric infarction, who were enrolled 
in the Hemicraniectomy After Middle cerebral artery infarction with 
Life-threatening Edema Trial within 4 days after stroke onset, were followed up 
at 3 years. Outcome measures included functional outcome (modified Rankin 
Scale), death, quality of life, and place of residence. Poor functional outcome 
was defined as modified Rankin Scale >3.
RESULTS: Of 64 included patients, 32 were randomized to decompressive surgery 
and 32 to best medical treatment. Just as at 1 year, surgery had no effect on 
the risk of poor functional outcome at 3 years (absolute risk reduction, 1%; 95% 
confidence interval, -21 to 22), but it reduced case fatality (absolute risk 
reduction, 37%; 95% confidence interval, 14-60). Sixteen surgically treated 
patients and 8 controls lived at home (absolute risk reduction, 27%; 95% 
confidence interval, 4-50). Quality of life improved between 1 and 3 years in 
patients treated with surgery.
CONCLUSIONS: In patients with space-occupying hemispheric infarction, the 
effects of decompressive surgery on case fatality and functional outcome 
observed at 1 year are sustained at 3 years.
CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique 
identifier: ISRCTN94237756.