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Published on: October 23, 2020
Clinical Benefit of Thrombectomy in Large-Core Infarction Patients Is Mediated by Malignant Cerebral Edema Reduction
Xiangjun Xu1, Xu Xu2, Jinfu Ma3
1Department of Neurology The First Affiliated Hospital of Wannan Medical College Wuhu Anhui Province China.
Background:
The impact of endovascular thrombectomy-mediated reperfusion on malignant cerebral edema (MCE) in large-core infarction remains unclear. We assessed the reperfusion-MCE relationship and MCE's mediating role in poor outcomes.
Methods:
This retrospective analysis used data from the national MAGIC (Prospective Multicenter Registry on Early Management of Acute Ischemic Stroke) registry (750 patients with large-core infarction, 38 Chinese centers, 2021-2023). MCE was defined as a midline shift of ≥5 mm on follow-up imaging within 72 hours after stroke onset. Recanalization was confirmed by computed tomography angiogram or magnetic resonance angiogram during hospitalization in the overall cohorts. Successful reperfusion was defined using the modified Treatment in Cerebral Ischemia classification 2b-3 in the endovascular thrombectomy arm. Functional outcome was 90-day modified Rankin scale score. Mediation analysis used reperfusion status as the independent variable and MCE as the mediator.
Results:
Among 698 patients, (306 women [43.8%]; median age, 70 [interquartile range, 61-78] years; median, Alberta Stroke Program Early Computed Tomography] Scores, 4 [interquartile range, 2-5]), successful recanalization (adjusted odds ratio [aOR], 0.68 [95% CI, 0.47-0.99]; P=0.042) and reperfusion (aOR, 0.34 [95% CI, 0.18-0.67]; P=0.002) reduced MCE likelihood. MCE was partially responsible for worse modified Rankin Scale scores in patients without recanalization or reperfusion (MCE changed the logistic regression coefficients by 15.0% and 32.5%, respectively). Recanalization improved functional outcomes partly by mitigating MCE formation (indirect effect β=-0.10, 11.5% mediation proportion, P=0.028) in those with Alberta Stroke Program Early Computed Tomography Scores 3 to 5 but not in those with 0 to 2 (β=-0.26, P=0.140).
Conclusions:
Successful reperfusion attenuates MCE formation and improves clinical outcomes in patients with large-core infarction.
Insights
Successful reperfusion after endovascular thrombectomy significantly reduces malignant cerebral edema (MCE) in large-core infarction. This intervention also improves patient outcomes by mitigating MCE formation.
Area of Science:
- Neurology
- Interventional Cardiology
- Stroke Medicine
Background:
- The effect of endovascular thrombectomy-mediated reperfusion on malignant cerebral edema (MCE) in large-core infarction is not well understood.
- Malignant cerebral edema is a significant complication following large-core ischemic strokes.
Purpose of the Study:
- To investigate the relationship between reperfusion and MCE in patients with large-core infarction.
- To evaluate the mediating role of MCE in poor functional outcomes after stroke.
Main Methods:
- Retrospective analysis of 698 patients from the MAGIC registry (2021-2023).
- Malignant cerebral edema defined as midline shift ≥5 mm within 72 hours post-stroke.
- Successful reperfusion defined as modified Treatment in Cerebral Ischemia 2b-3; functional outcome assessed by 90-day modified Rankin Scale score.
Main Results:
- Successful recanalization (aOR 0.68) and reperfusion (aOR 0.34) were associated with a lower likelihood of MCE.
- Malignant cerebral edema partially explained worse outcomes in patients without successful reperfusion (15.0%-32.5% mediation).
- Recanalization improved functional outcomes by mitigating MCE in patients with Alberta Stroke Program Early Computed Tomography Scores of 3-5 (11.5% mediation).
Conclusions:
- Successful reperfusion is crucial in attenuating MCE formation in large-core infarction.
- Endovascular thrombectomy-mediated reperfusion improves clinical outcomes by reducing MCE.
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