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Updated: Feb 24, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy
Alessandro Davoli1, Caterina Motta1,2, Giacomo Koch1,2
1Department of Neuroscience, Comprehensive Stroke Center, University of Tor Vergata, Rome, Italy.
Background:
Few data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.
Methods:
Patients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.
Results:
98 patients were included in the analysis, 35 of whom developed MMI (35.7%). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46%; specificity 97%; positive predictive value 78%; negative predictive value 65%).
Conclusions:
in our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.
Insights
Predicting malignant middle cerebral artery infarction (MMI) after endovascular treatment (ET) for acute ischemic stroke (AIS) is crucial. High admission systolic blood pressure, blood glucose, and low CT angiography ASPECTS scores are key predictors.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischemic stroke (AIS).
- Limited data exist on MMI predictors in patients undergoing endovascular treatment (ET).
- A comprehensive model for MMI prediction post-ET is needed.
Purpose of the Study:
- To identify robust clinical and radiological predictors of MMI in AIS patients treated with ET.
- To develop a practical model for predicting MMI evolution.
Main Methods:
- Retrospective analysis of a prospective single-center database of AIS patients undergoing ET.
- Investigation of demographic, clinical, and radiological data.
- Multivariate regression analysis to identify independent predictors.
Main Results:
- 35.7% of 98 patients developed MMI.
- No significant differences in reperfusion rates or time to reperfusion between MMI and non-MMI groups.
- Independent predictors identified: admission systolic blood pressure (SBP), blood glucose (BG), and CT angiography Alberta Stroke Program Early CT Score (CTA ASPECTS). CTA ASPECTS ≤5 was the strongest predictor (97% specificity).
Conclusions:
- A model based on clinical and radiological features effectively predicts MMI evolution in AIS patients undergoing ET.
- High admission SBP, BG, and particularly a CTA ASPECTS ≤5 are valuable indicators for rapid clinical decision-making.
- These predictors are useful regardless of time to treatment or reperfusion success.
