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Predictors of Malignant Cerebral Edema Following Mechanical Thrombectomy in Acute Ischemic Stroke: A Retrospective

Zhenye Liu1, Yuning Lin2, Xiaoling Duan1

  • 1Department of Radiology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Radiology, The 900th Hospital of Joint Logistic Support Force, PLA, FuJian, China.

World Neurosurgery
|November 22, 2025
PubMed
Abstract

Insights

This study identifies key predictors of malignant cerebral edema (MCE) following mechanical thrombectomy for acute ischemic stroke. A new nomogram helps predict MCE risk, aiding early clinical decisions for stroke patients.

Area of Science:

  • Neurology
  • Radiology
  • Critical Care Medicine

Background:

  • Mechanical thrombectomy (MT) is a crucial treatment for acute ischemic stroke (AIS).
  • Malignant cerebral edema (MCE) is a serious complication post-MT, significantly impacting patient outcomes.
  • Identifying risk factors for MCE is vital for improving patient management.

Purpose of the Study:

  • To determine the risk factors associated with malignant cerebral edema (MCE) after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS).
  • To develop and validate a clinical prediction nomogram for MCE risk post-MT.

Main Methods:

  • Retrospective analysis of 284 AIS patients who underwent successful MT.
  • Patients were divided into training (80%) and validation (20%) cohorts.
  • Logistic regression identified independent risk factors; a nomogram was constructed and validated using AUC.

Main Results:

  • 49 (17%) patients developed MCE, associated with poorer 90-day functional outcomes (88% vs. 45%).
  • Predictors included Alberta Stroke Project Early CT Score, Hyperdensity on CT Score, NIH Stroke Scale, neutrophil-lymphocyte ratio, and prolonged puncture-to-reperfusion time (>120 min).
  • The nomogram demonstrated excellent predictive performance (AUC 0.941 in training, 0.964 in validation).

Conclusions:

  • A novel nomogram incorporating five clinical and imaging variables effectively predicts MCE risk post-MT.
  • This tool can assist clinicians in early decision-making for AIS patients undergoing MT.
  • Early risk stratification may lead to timely interventions and improved patient outcomes.
Keywords:
Acute ischemic strokeMalignant cerebral edemaMechanical thrombectomyNomogram

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