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Updated: Dec 16, 2025
Embolic Middle Cerebral Artery Occlusion MCAO for Ischemic Stroke with Homologous Blood Clots in Rats
Published on: September 17, 2014
Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy
C Tracol1, S Vannier2, C Hurel3
1Neurology, university hospital, 37, quai de la Prevalaye, 35000 Rennes, France.
Introduction:
Several predictors have been described to early diagnose malignant middle cerebral artery infarction (MMI) and select patient for hemicraniectomy. Nevertheless, few studies have assessed them among patients with acute ischemic stroke undergoing mechanical endovascular thrombectomy (MET). The overall objective in this study was to evaluate these predictors in patients undergoing MET in the purpose to guide the medical care in the acute phase.
Methods:
We selected patients from a prospective local database which reference all patients eligible for treatment with Alteplase thrombolysis and/or mechanical endovascular thrombectomy in acute stroke. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.
Results:
In 32 months, 66 patients were included. Eighteen (27.3%) developed MMI. Malignant evolution was associated with: severity of neurological deficit and level of consciousness at admission, infarct size in DWI sequence and involvement of other vascular territories. Study groups didn't differ in terms of successful reperfusion. Two variables were identified as independent predictors of MMI: DWI infarct volume (p<0.001) and time to thrombectomy (p=0.018). A decision tree based on these two factors was able to predict malignant evolution with high specificity (100%) and sensibility (73%).
Conclusion:
Our study proposes a practical decision tree including DWI lesion volume and delay before thrombectomy to early and accurately predict MMI in a subgroup of patients with MCA infarction undergoing MET regardless to the status of reperfusion.
Insights
A new decision tree accurately predicts malignant middle cerebral artery infarction (MMI) in stroke patients undergoing mechanical endovascular thrombectomy (MET). It uses DWI infarct volume and time to thrombectomy to guide acute care.
Area of Science:
- Neurology
- Stroke Medicine
- Interventional Neuroradiology
Background:
- Early diagnosis of malignant middle cerebral artery infarction (MMI) is crucial for selecting patients for hemicraniectomy.
- Few studies have evaluated MMI predictors in patients undergoing mechanical endovascular thrombectomy (MET).
Purpose of the Study:
- To evaluate predictors of MMI in patients undergoing MET.
- To guide acute medical care for stroke patients receiving MET.
Main Methods:
- Prospective database of acute stroke patients eligible for thrombolysis and/or MET.
- Analysis of demographic, clinical, and radiological data.
- Multivariate regression to identify MMI predictors.
Main Results:
- 18 of 66 patients (27.3%) developed MMI.
- Independent predictors identified: DWI infarct volume (p<0.001) and time to thrombectomy (p=0.018).
- A decision tree achieved 100% specificity and 73% sensitivity for predicting MMI.
Conclusions:
- A practical decision tree incorporating DWI lesion volume and time to thrombectomy can accurately predict MMI.
- This tool aids early prediction in MCA infarction patients undergoing MET, irrespective of reperfusion status.
