The risk and outcome of malignant brain edema in post-mechanical thrombectomy: acute ischemic stroke by anterior circulation occlusion

European Journal of Medical Research

Research

Mingyu Zou¹  Xinrui Wang¹  Yang Duan¹  Hongyan Song¹  Lin Shi¹  Luojin Zhang²  Jinze Li³  Wei Li⁴  Benqiang Yang⁵ 

[1] Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China;Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China;Department of Radiology, Shanxi Fenyang Hospital, Shanxi, China;Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China;Northern Theater Command Postgraduate Training Base of Jinzhou Medical University General Hospital, Shenyang, China;Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China;Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China;

关键词: Acute ischemic stroke;    Malignant brain edema;    Mechanical thrombectomy;    Large vessel occlusion;    Hyperdense middle cerebral artery sign;   

DOI  :  10.1186/s40001-023-01414-x

 received in 2023-07-15, accepted in 2023-09-30,  发布年份 2023

来源: Springer

【 摘 要 】

Background and purposeMalignant brain edema (MBE) occurring after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) could lead to severe disability and mortality. We aimed to investigate the incidence, predictors, and clinical outcomes of MBE in patients with AIS after MT.MethodsThe clinical and imaging data of 155 patients with AIS of anterior circulation after MT were studied. Standard non-contrast CT was used to evaluate baseline imaging characteristics at admission. Clinical outcomes were measured using the 90-day modified Rankin Scale (mRS) score. Based on the follow-up CT scans performed within 72 h after MT, the patients were classified into MBE and non-MBE group. MBE was defined as a midline shift of ≥ 5 mm with signs of local brain swelling. Univariate and multivariate regression analyses were used to analyze the relationship between MBE and clinical outcomes and identify the predictors that correlate with MBE.ResultsMBE was observed in 19.4% of the patients who underwent MT and was associated with a lower rate of favorable 90-day clinical outcomes. Significant differences were observed in both MBE and non-MBE groups: baseline Alberta Stroke Program Early CT (ASPECT) score, hyperdense middle cerebral artery sign (HMCAS), baseline signs of early infarct, angiographic favorable collaterals, number of retrieval attempts, and revascularization rate. Multivariate analysis indicated that low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count, and poor revascularization independently influenced the occurrence of MBE in AIS patients with anterior circulation after MT.ConclusionMBE was associated with a lower rate of favorable 90-day clinical outcomes. Low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count and poor revascularization were independently associated with MBE after MT.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 4

Fig. 2