Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
Guasch-Jiménez, Marina (Universitat Autònoma de Barcelona. Departament de Medicina)
Dhar, Rajat (Washington University in Saint Louis)
Kumar, Atul (Washington University in Saint Louis)
Cifarelli, Julien (Washington University in Saint Louis)
Ezcurra-Díaz, Garbiñe (Institut de Recerca Sant Pau)
Lambea-Gil, Álvaro (Institut de Recerca Sant Pau)
Ramos-Pachón, Anna (Institut de Recerca Sant Pau)
Martínez-Domeño, Alejandro (Institut de Recerca Sant Pau)
Prats-Sánchez, Luis (Institut de Recerca Sant Pau)
Guisado-Alonso, Daniel (Institut de Recerca Sant Pau)
Fernandez-Cadenas, Israel (Institut de Recerca Sant Pau)
Aguilera-Simón, Ana (Institut de Recerca Sant Pau)
Marín, Rebeca (Institut de Recerca Sant Pau)
Martínez-González, José Pablo (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Ortega-Quintanilla, Joaquin (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Fernandez-Perez, Isabel (Hospital del Mar (Barcelona, Catalunya))
Avellaneda-Gómez, Carla (Hospital del Mar (Barcelona, Catalunya))
Rodríguez-Pardo, Jorge (Hospital Universitario La Paz (Madrid))
De Celis Ruiz, Elena (Hospital Universitario La Paz (Madrid))
Moniche, Francisco (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Freijo, María del Mar (Hospital Universitario de Cruces (Barakaldo, País Basc))
Cortijo, Elisa (Hospital Clínico Universitario de Valladolid)
Trillo, Santiago (Hospital Universitario de la Princesa (Madrid))
Camps-Renom, Pol (Institut de Recerca Sant Pau)
Martí-Fàbregas, Joan (Institut de Recerca Sant Pau)

Date:	2025
Abstract:	Background: Cerebral edema (CED) is associated with poorer outcome in patients with acute ischemic stroke (AIS). The aim of the study was to investigate the factors contributing to greater early CED formation in patients with AIS who underwent endovascular therapy (EVT) and its association with functional outcome. Methods: We conducted a multicenter cohort study of patients with an anterior circulation AIS undergoing EVT. The volume of cerebrospinal fluid (CSF) was extracted from baseline and 24-hour follow-up CT using an automated algorithm. The severity of CED was quantified by the percentage reduction in CSF volume between CT scans (∆CSF). The primary endpoint was a shift towards an unfavorable outcome, assessed by modified Rankin Scale (mRS) score at 3 months. Multivariable ordinal logistic regression analyses were performed. The ∆CSF threshold that predicted unfavorable outcome was selected using receiver operating characteristic curve analysis. Results: We analyzed 201 patients (mean age 72. 7 years, 47. 8% women) in whom CED was assessable for 85. 6%. Higher systolic blood pressure during EVT and failure to achieve modified Thrombolysis In Cerebral Infarction (mTICI) 3 were found to be independent predictors of greater CED. ∆CSF was independently associated with the probability of a one-point worsening in the mRS score (common odds ratio (cOR) 1. 05, 95% CI 1. 03 to 1. 08) after adjusting for age, baseline mRS, National Institutes of Health Stroke Scale (NIHSS), and number of passes. Displacement of more than 25% of CSF was associated with an unfavorable outcome (OR 6. 09, 95% CI 3. 01 to 12. 33) and mortality (OR 6. 72, 95% CI 2. 94 to 15. 32). Conclusions: Early CED formation in patients undergoing EVT was affected by higher blood pressure and incomplete reperfusion. The extent of early CED, measured by automated ∆CSF, was associated with worse outcomes.
Grants:	Instituto de Salud Carlos III PI19/00859
Note:	Altres ajuts: Redes de Investigación Con Objetivos de Resultados en Salud (RD21/0006/0006)
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Language:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Subject:	Ischemic stroke ; Cerebral edema ; Endovascular therapy ; Thrombectomy
Published in:	Journal of neurointerventional surgery, Vol. 17, Núm. 4 (March 2025) , ISSN 1759-8486

DOI: 10.1136/jnis-2024-021641
PMID: 38637151

Postprint 18 p, 298.6 KB

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