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Association between microvascular cerebral circulation time, malignant brain edema and outcome after successful

Yapeng Guo1, Jia Fang2, Yuepei Gao1

  • 1Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China.

European Radiology
|February 11, 2026
PubMed
Abstract

Insights

Prolonged microvascular cerebral circulation time (mCCT) after successful endovascular thrombectomy (EVT) predicts malignant brain edema (MBE) and poor outcomes. This measure offers a valuable intraprocedural biomarker for patient prognostication and management.

Area of Science:

  • Neuroscience
  • Medical Imaging
  • Vascular Neurology

Background:

  • Microvascular cerebral circulation time (mCCT) prolongation post-endovascular thrombectomy (EVT) may indicate impaired cerebral microcirculation.
  • The relationship between mCCT, malignant brain edema (MBE), and functional outcomes in large vessel occlusion stroke (LVOS) post-EVT requires further clarification.

Purpose of the Study:

  • To investigate the association between prolonged mCCT and the development of MBE after successful EVT in LVOS patients.
  • To determine if mCCT predicts functional outcomes following EVT for LVOS.
  • To explore the mediating role of MBE in the relationship between mCCT and functional outcomes.

Main Methods:

  • Retrospective analysis of 358 anterior circulation LVOS patients undergoing successful EVT.
  • Intraprocedural mCCT measurement using DSA and syngo iFlow.
  • Assessment of MBE on follow-up imaging within 72 hours.
  • Modified Rankin Scale (mRS) score at 90 days for functional outcome.
  • Logistic regression and mediation analysis to test associations.

Main Results:

  • Prolonged mCCT was significantly associated with MBE development (p < 0.001).
  • mCCT independently predicted both MBE (aOR = 2.703) and unfavorable functional outcomes (mRS > 2; aOR = 3.450).
  • Adding mCCT to existing models significantly improved MBE prediction discrimination (AUC 0.915 vs 0.868; p = 0.015).
  • MBE did not significantly mediate the relationship between mCCT and functional outcome (p = 0.200).

Conclusions:

  • Prolonged mCCT is a significant predictor of MBE and unfavorable functional outcomes after successful EVT for LVOS.
  • The impact of mCCT on prognosis appears largely independent of MBE.
  • Intraprocedural mCCT measurement serves as a valuable biomarker for prognostication and guiding early post-EVT management.
Keywords:
Endovascular thrombectomyFunctional outcomeLarge vessel occlusion strokeMalignant brain edemaMicrovascular cerebral circulation time

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