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Prediction of Malignant Brain Edema Based on Contrast Agent Exudation After Mechanical Thrombectomy for Anterior

Youcai Bi1, Shengwu Wang1, Yingying Mu Rong1

  • 1Departments of Neurology.

The Neurologist
|April 2, 2026
PubMed
Abstract

Insights

Lower contrast agent extravasation (CAE)-Alberta Stroke Program Early CT Score (ASPECTS) after mechanical thrombectomy (MT) predicts malignant brain edema (MBE). This imaging biomarker aids in assessing post-MT risk for stroke patients.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Malignant brain edema (MBE) following mechanical thrombectomy (MT) for anterior circulation occlusion is associated with poor patient outcomes.
  • Contrast agent extravasation (CAE) signifies blood-brain barrier disruption, but its predictive capability for MBE requires further investigation.

Purpose of the Study:

  • To evaluate the predictive value of the CAE-Alberta Stroke Program Early CT Score (CAE-ASPECTS) for MBE after MT in anterior circulation occlusion.
  • To identify factors influencing MBE development and assess the association of CAE-ASPECTS with clinical outcomes.

Main Methods:

  • Patients undergoing MT for anterior circulation occlusion were categorized into MBE and non-MBE groups.
  • Postoperative CAE-ASPECTS were analyzed to determine their predictive value for MBE.
  • Secondary analyses examined factors influencing MBE and correlations with 90-day modified Rankin Scale (mRS) and 72-hour intracerebral hemorrhage.

Main Results:

  • The MBE group exhibited significantly lower median postoperative CAE-ASPECTS.
  • CAE-ASPECTS independently predicted MBE, with lower scores indicating increased risk.
  • Lower CAE-ASPECTS, higher NIHSS scores, and longer operative times were associated with higher MBE risk. The predictive model achieved 93% accuracy.
  • Favorable 90-day mRS and lower mortality were observed in the non-MBE group. Cerebral hemorrhage transformation was inversely correlated with CAE-ASPECTS.

Conclusions:

  • Reduced CAE-ASPECTS scores are significantly linked to a higher incidence of MBE post-MT.
  • CAE-ASPECTS serves as an independent predictor of MBE and is negatively correlated with cerebral hemorrhage transformation.
  • A combination of CAE-ASPECTS, preoperative NIHSS, ASPECTS, and operative time predicts MBE with 93% sensitivity, offering a valuable imaging biomarker for risk stratification.
Keywords:
anterior circulation large vessel occlusioncontrast extravasationmalignant brain edemamechanical thrombectomy

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