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

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Luojin Zhang1,2, Jinze Li1,3, Benqiang Yang4

  • 1Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China.

European Journal of Medical Research
|October 14, 2023
PubMed
Abstract

Insights

Malignant brain edema (MBE) after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) occurs in 19.4% of patients. Poor revascularization and low baseline scores are key predictors, leading to worse outcomes.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Malignant brain edema (MBE) following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is a critical complication.
  • MBE can significantly increase disability and mortality rates in AIS patients.

Purpose of the Study:

  • To determine the incidence of MBE after MT in AIS patients.
  • To identify predictors associated with MBE development.
  • To evaluate the clinical outcomes in patients with and without MBE.

Main Methods:

  • Retrospective analysis of 155 AIS patients who underwent MT for anterior circulation stroke.
  • Evaluation of baseline non-contrast CT and follow-up CT scans (within 72 hours) for MBE diagnosis (midline shift ≥5 mm).
  • Statistical analysis including univariate and multivariate regression to identify MBE predictors and outcomes (90-day mRS).

Main Results:

  • MBE was identified in 19.4% of patients and was linked to poorer 90-day functional outcomes.
  • Significant differences between MBE and non-MBE groups included baseline ASPECT score, HMCAS, early infarct signs, collateral status, retrieval attempts, and revascularization rates.
  • Multivariate analysis revealed low baseline ASPECT score, absent HMCAS, poor collaterals, increased retrieval attempts, and poor revascularization as independent predictors of MBE.

Conclusions:

  • MBE is a significant complication of MT in AIS, associated with unfavorable clinical outcomes.
  • Predictors of MBE include low baseline ASPECT score, absent HMCAS, poor angiographic collaterals, and technical factors like multiple retrieval attempts and failed revascularization.
Keywords:
Acute ischemic strokeHyperdense middle cerebral artery signLarge vessel occlusionMalignant brain edemaMechanical thrombectomy

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