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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Predictors for Cerebral Edema in Acute Ischemic Stroke Treated With Intravenous Thrombolysis
Magnus Thorén1, Elsa Azevedo2, Jesse Dawson2
1From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.). magnus.thoren@sll.se.
Insights
Predictors for early cerebral edema (CED) after stroke include higher NIH Stroke Scale scores, hyperdense artery signs, elevated blood glucose, and infarct signs. These findings aid patient selection for treatments.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Cerebral edema (CED) is a serious complication following acute ischemic stroke.
- Predictors for CED development after cerebral infarction remain uncertain.
- Identifying these predictors is crucial for patient management.
Purpose of the Study:
- To determine which baseline clinical and radiological parameters predict the development of CED.
- To investigate predictors in patients treated with intravenous thrombolysis for acute ischemic stroke.
Main Methods:
- Utilized an image-based classification for CED severity (CED 1-3) on post-thrombolysis scans.
- Analyzed data from 42,187 patients in the SITS International Register (2002-2011).
- Employed univariate comparisons and backward logistic regression to identify predictors.
Main Results:
- CED was detected in 22.7% of patients.
- Higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, hyperdense artery sign, elevated blood glucose, impaired consciousness, and infarct signs were associated with CED.
- NIHSS score (17 vs 10), infarct signs (27.9% vs 19.2%), hyperdense artery sign (37.6% vs 14.6%), and blood glucose (6.8 vs 6.4 mmol/L) were significantly different in patients with CED.
Conclusions:
- Key baseline predictors for early CED include NIHSS score, hyperdense artery sign, higher blood glucose, decreased consciousness, and infarct signs.
- These identified predictors can enhance patient selection and monitoring for therapeutic interventions.
- The study provides valuable insights for managing stroke patients at risk of cerebral edema.
Background And Purpose:
Cerebral edema (CED) is a severe complication of acute ischemic stroke. There is uncertainty regarding the predictors for the development of CED after cerebral infarction. We aimed to determine which baseline clinical and radiological parameters predict development of CED in patients treated with intravenous thrombolysis.
Methods:
We used an image-based classification of CED with 3 degrees of severity (less severe CED 1 and most severe CED 3) on postintravenous thrombolysis imaging scans. We extracted data from 42 187 patients recorded in the SITS International Register (Safe Implementation of Treatments in Stroke) during 2002 to 2011. We did univariate comparisons of baseline data between patients with or without CED. We used backward logistic regression to select a set of predictors for each CED severity.
Results:
CED was detected in 9579/42 187 patients (22.7%: 12.5% CED 1, 4.9% CED 2, 5.3% CED 3). In patients with CED versus no CED, the baseline National Institutes of Health Stroke Scale score was higher (17 versus 10; P<0.001), signs of acute infarct was more common (27.9% versus 19.2%; P<0.001), hyperdense artery sign was more common (37.6% versus 14.6%; P<0.001), and blood glucose was higher (6.8 versus 6.4 mmol/L; P<0.001). Baseline National Institutes of Health Stroke Scale, hyperdense artery sign, blood glucose, impaired consciousness, and signs of acute infarct on imaging were independent predictors for all edema types.
Conclusions:
The most important baseline predictors for early CED are National Institutes of Health Stroke Scale, hyperdense artery sign, higher blood glucose, decreased level of consciousness, and signs of infarct at baseline. The findings can be used to improve selection and monitoring of patients for drug or surgical treatment.
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