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 func...

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Autores: Guasch-Jiménez, Marina|||0000-0001-6024-8348, Dhar, Rajat|||0000-0002-5167-5097, Kumar, Atul, Cifarelli, Julien, Ezcurra Diaz, Garbiñe|||0000-0002-9511-3117, Lambea-Gil, Álvaro|||0000-0003-1785-9201, Ramos-Pachón, Anna|||0000-0002-7136-4245, Martínez-Domeño, Alejandro|||0000-0002-9933-3192, Prats Sánchez, Luis Antonio|||0000-0002-3192-4631, Guisado-Alonso, Daniel|||0000-0002-5799-3184, Fernández Cadenas, Israel|||0000-0003-4821-2363, Aguilera-Simón, Ana|||0000-0003-1428-8212, Marín-Bueno, Rebeca|||0000-0002-0354-6602, Martínez-González, José Pablo|||0000-0002-5925-1010, Ortega-Quintanilla, Joaquin, Fernandez-Perez, Isabel|||0000-0002-9949-1393, Avellaneda-Gómez, Carla|||0000-0003-4851-1224, Rodríguez-Pardo, Jorge, De Celis Ruiz, Elena|||0000-0002-9224-9422, Moniche, Francisco|||0000-0001-8613-2909, Freijo, María del Mar, Cortijo, Elisa, Trillo, Santiago, Camps-Renom, Pol|||0000-0001-6587-6271, Martí-Fàbregas, Joan|||0000-0001-9229-8649
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:311277
Acceso en línea:https://ddd.uab.cat/record/311277
https://dx.doi.org/urn:doi:10.1136/jnis-2024-021641
Access Level:acceso abierto
Palabra clave:Ischemic stroke
Cerebral edema
Endovascular therapy
Thrombectomy
Descripción
Sumario: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.

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