Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome

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 funct...

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Autores: Guasch-Jiménez, M, Dhar, R, Kumar, A, Cifarelli, J, Ezcurra-Díaz, G, Lambea-Gil, A, Ramos-Pachón, A, Martínez-Domeño, A, Prats-Sánchez, L, Guisado-Alonso, D, Fernández-Cadenas, I, Aguilera-Simón, A, Marín, R, Martínez-González, J, Ortega-Quintanilla, J, Fernández-Pérez,I, Avellaneda-Gómez, C, Rodríguez-Pardo, J, de Celis, E, Moniche, F, Freijo, M, Cortijo, E, Trillo, S, Camps-Renom, P, Martí-Fábregas , J
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2025
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositório:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p17658
Acesso em linha:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17658
Access Level:Acceso aberto
Palavra-chave:Stroke
Thrombectomy
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spelling Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcomeGuasch-Jiménez, MDhar, RKumar, ACifarelli, JEzcurra-Díaz, GLambea-Gil, ARamos-Pachón, AMartínez-Domeño, APrats-Sánchez, LGuisado-Alonso, DFernández-Cadenas, IAguilera-Simón, AMarín, RMartínez-González, JOrtega-Quintanilla, JFernández-Pérez,IAvellaneda-Gómez, CRodríguez-Pardo, Jde Celis, EMoniche, FFreijo, MCortijo, ETrillo, SCamps-Renom, PMartí-Fábregas , JStrokeThrombectomyBackground 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 ( increment 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 increment 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. increment 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 increment CSF, was associated with worse outcomes.BMJ PUBLISHING GROUP2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17658Journal of NeuroInterventional SurgeryISSN: 17598478ISSNe: 17598486reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p176582026-06-14T12:41:47Z
dc.title.none.fl_str_mv Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
title Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
spellingShingle Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
Guasch-Jiménez, M
Stroke
Thrombectomy
title_short Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
title_full Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
title_fullStr Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
title_full_unstemmed Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
title_sort Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
dc.creator.none.fl_str_mv Guasch-Jiménez, M
Dhar, R
Kumar, A
Cifarelli, J
Ezcurra-Díaz, G
Lambea-Gil, A
Ramos-Pachón, A
Martínez-Domeño, A
Prats-Sánchez, L
Guisado-Alonso, D
Fernández-Cadenas, I
Aguilera-Simón, A
Marín, R
Martínez-González, J
Ortega-Quintanilla, J
Fernández-Pérez,I
Avellaneda-Gómez, C
Rodríguez-Pardo, J
de Celis, E
Moniche, F
Freijo, M
Cortijo, E
Trillo, S
Camps-Renom, P
Martí-Fábregas , J
author Guasch-Jiménez, M
author_facet Guasch-Jiménez, M
Dhar, R
Kumar, A
Cifarelli, J
Ezcurra-Díaz, G
Lambea-Gil, A
Ramos-Pachón, A
Martínez-Domeño, A
Prats-Sánchez, L
Guisado-Alonso, D
Fernández-Cadenas, I
Aguilera-Simón, A
Marín, R
Martínez-González, J
Ortega-Quintanilla, J
Fernández-Pérez,I
Avellaneda-Gómez, C
Rodríguez-Pardo, J
de Celis, E
Moniche, F
Freijo, M
Cortijo, E
Trillo, S
Camps-Renom, P
Martí-Fábregas , J
author_role author
author2 Dhar, R
Kumar, A
Cifarelli, J
Ezcurra-Díaz, G
Lambea-Gil, A
Ramos-Pachón, A
Martínez-Domeño, A
Prats-Sánchez, L
Guisado-Alonso, D
Fernández-Cadenas, I
Aguilera-Simón, A
Marín, R
Martínez-González, J
Ortega-Quintanilla, J
Fernández-Pérez,I
Avellaneda-Gómez, C
Rodríguez-Pardo, J
de Celis, E
Moniche, F
Freijo, M
Cortijo, E
Trillo, S
Camps-Renom, P
Martí-Fábregas , J
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Stroke
Thrombectomy
topic Stroke
Thrombectomy
description 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 ( increment 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 increment 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. increment 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 increment CSF, was associated with worse outcomes.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17658
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17658
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMJ PUBLISHING GROUP
publisher.none.fl_str_mv BMJ PUBLISHING GROUP
dc.source.none.fl_str_mv Journal of NeuroInterventional Surgery
ISSN: 17598478
ISSNe: 17598486
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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