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Measuring Post-Stroke Cerebral Edema, Infarct Zone and Blood-Brain Barrier Breakdown in a Single Set of Rodent Brain Samples
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Predictors and outcome of malignant cerebral edema after successful reperfusion in anterior circulation stroke

Mingjun Pu1, Jun Chen2, Zhonglun Chen2

  • 1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, China.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|April 27, 2023
PubMed
Abstract

Insights

Malignant cerebral edema (MCE) after successful endovascular thrombectomy (EVT) occurs in 15.6% of patients, predicting poor outcomes. Key predictors include glucose, NIHSS score, etiology, occlusion site, and longer puncture-to-reperfusion times.

Area of Science:

  • Neurology
  • Neurosurgery
  • Stroke Medicine

Background:

  • Malignant cerebral edema (MCE) is a severe complication following successful endovascular thrombectomy (EVT) for acute ischemic stroke.
  • Predictors and incidence of MCE post-EVT require further elucidation.

Purpose of the Study:

  • To evaluate the incidence of MCE after successful reperfusion in ischemic stroke patients treated with EVT.
  • To identify risk factors and develop a predictive model for MCE post-EVT.

Main Methods:

  • Retrospective analysis of 307 ischemic stroke patients undergoing EVT (November 2015 - April 2022).
  • Exclusion of patients with failed reperfusion (mTICI < 2b).
  • Development and validation of a predictive nomogram using multivariate logistic regression and ROC analysis.

Main Results:

  • MCE was diagnosed in 48 (15.6%) patients post-successful reperfusion.
  • MCE patients exhibited significantly worse 3-month outcomes (favorable: 15.2% vs 59.6%; good: 17.4% vs 68.4%) and higher mortality (54.3% vs 8.8%).
  • Predictors identified: admission glucose, baseline NIHSS score, stroke etiology, occlusion site, and puncture-to-reperfusion (PTR) time > 120 min. Nomogram AUC: 0.805.

Conclusions:

  • MCE post-successful EVT is strongly associated with poor functional outcomes and increased mortality.
  • A nomogram incorporating admission glucose, baseline NIHSS, stroke etiology, occlusion site, and PTR time can predict MCE risk in EVT-treated stroke patients.
Keywords:
Endovascular thrombectomyMalignant cerebral edemaPredictorSuccessful reperfusion

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