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Published on: October 23, 2020
Association Between Hypoperfusion Intensity Ratio and Postthrombectomy Malignant Brain Edema for Acute Ischemic
Wang Chen1, Xianjun Wang2, Ji Liu2
1Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang, Beijing, 100020, China.
Background:
Malignant brain edema (MBE) is a life-threatening complication that can occur after mechanical thrombectomy (MT) for acute ischemic stroke. The hypoperfusion intensity ratio (HIR) reflects the tissue-level perfusion status within the ischemic territory. This study investigated the association between HIR and MBE occurrence after MT in patients with anterior circulation large artery occlusion.
Methods:
We conducted a retrospective cohort study of patients who received MT at a comprehensive stroke center from February 2020 to June 2022. Using computed tomography perfusion, the HIR was derived from the ratio of tissue volume with a time to maximum (Tmax) > 10 s to that with a Tmax > 6 s. We dichotomized patients based on the occurrence of MBE following MT. The primary outcome, assessed using a multivariable logistic regression model, was the MBE occurrence post MT. The secondary outcome focused on favorable outcomes, defined as achieving a modified Rankin Scale score of 0-2 at 90 days.
Results:
Of the 603 included patients, 90 (14.9%) developed MBE after MT. The median HIR exhibited a significantly higher value in the MBE group compared with the non-MBE group (0.5 vs. 0.3; P < 0.001). Multivariable logistic regression analysis indicated that a higher HIR (adjusted odds ratio [aOR] 8.98; 95% confidence interval [CI] 2.85-28.25; P < 0.001), baseline large infarction (Alberta Stroke Program Early Computed Tomography Score < 6; aOR 1.77; 95% CI 1.04-3.01; P = 0.035), internal carotid artery occlusion (aOR 1.80; 95% CI 1.07-3.01; P = 0.028), and unsuccessful recanalization (aOR 8.45; 95% CI 4.75-15.03; P < 0.001) were independently associated with MBE post MT. Among those with successful recanalization, a higher HIR (P = 0.017) and baseline large infarction (P = 0.032) remained as predictors of MBE occurrence. Furthermore, a higher HIR (P = 0.001) and the occurrence of MBE (P < 0.001) both correlated with reduced odds of achieving favorable outcomes.
Conclusions:
The presence of a higher HIR on pretreatment perfusion imaging serves as a robust predictor for MBE occurrence after MT, irrespective of successful recanalization.
Insights
A higher hypoperfusion intensity ratio (HIR) on pretreatment imaging predicts malignant brain edema (MBE) after mechanical thrombectomy (MT) for stroke. This finding holds true regardless of successful recanalization, impacting patient outcomes.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Malignant brain edema (MBE) is a critical complication following mechanical thrombectomy (MT) for acute ischemic stroke.
- The hypoperfusion intensity ratio (HIR) quantifies tissue perfusion within the ischemic area.
Purpose of the Study:
- To investigate the association between HIR and the occurrence of MBE after MT in patients with anterior circulation large artery occlusion.
- To identify predictors of MBE and their impact on functional outcomes.
Main Methods:
- Retrospective cohort study of 603 patients undergoing MT from February 2020 to June 2022.
- HIR calculated from computed tomography perfusion imaging (Tmax > 10s / Tmax > 6s).
- Multivariable logistic regression used to assess MBE occurrence and 90-day functional outcomes (modified Rankin Scale).
Main Results:
- 14.9% of patients developed MBE post-MT.
- Higher HIR was significantly associated with MBE occurrence (aOR 8.98, P < 0.001).
- Independent predictors of MBE included higher HIR, large baseline infarction, internal carotid artery occlusion, and unsuccessful recanalization.
- Higher HIR and MBE occurrence correlated with reduced odds of favorable functional outcomes.
Conclusions:
- Pretreatment HIR is a strong predictor of MBE following MT for acute ischemic stroke.
- HIR predicts MBE irrespective of recanalization success.
- Elevated HIR is linked to poorer functional outcomes post-stroke.
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