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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Authors: 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
Format: article
Publication Date:2025
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:311277
Online Access:https://ddd.uab.cat/record/311277
https://dx.doi.org/urn:doi:10.1136/jnis-2024-021641
Access Level:Open access
Keyword:Ischemic stroke
Cerebral edema
Endovascular therapy
Thrombectomy
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spelling Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcomeGuasch-Jiménez, Marina|||0000-0001-6024-8348Dhar, Rajat|||0000-0002-5167-5097Kumar, AtulCifarelli, JulienEzcurra Diaz, Garbiñe|||0000-0002-9511-3117Lambea-Gil, Álvaro|||0000-0003-1785-9201Ramos-Pachón, Anna|||0000-0002-7136-4245Martínez-Domeño, Alejandro|||0000-0002-9933-3192Prats Sánchez, Luis Antonio|||0000-0002-3192-4631Guisado-Alonso, Daniel|||0000-0002-5799-3184Fernández Cadenas, Israel|||0000-0003-4821-2363Aguilera-Simón, Ana|||0000-0003-1428-8212Marín-Bueno, Rebeca|||0000-0002-0354-6602Martínez-González, José Pablo|||0000-0002-5925-1010Ortega-Quintanilla, JoaquinFernandez-Perez, Isabel|||0000-0002-9949-1393Avellaneda-Gómez, Carla|||0000-0003-4851-1224Rodríguez-Pardo, JorgeDe Celis Ruiz, Elena|||0000-0002-9224-9422Moniche, Francisco|||0000-0001-8613-2909Freijo, María del MarCortijo, ElisaTrillo, SantiagoCamps-Renom, Pol|||0000-0001-6587-6271Martí-Fàbregas, Joan|||0000-0001-9229-8649Ischemic strokeCerebral edemaEndovascular therapyThrombectomyBackground: 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. 22025-01-0120252025-01-01Articlehttp://purl.org/coar/resource_type/c_6501AMhttp://purl.org/coar/version/c_ab4af688f83e57aainfo:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/311277https://dx.doi.org/urn:doi:10.1136/jnis-2024-021641reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI19/00859open accesshttp://purl.org/coar/access_right/c_abf2Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets.https://rightsstatements.org/vocab/InC/1.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3112772026-06-06T12:50:31Z
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, Marina|||0000-0001-6024-8348
Ischemic stroke
Cerebral edema
Endovascular therapy
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, 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
author Guasch-Jiménez, Marina|||0000-0001-6024-8348
author_facet 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
author_role author
author2 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
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 Ischemic stroke
Cerebral edema
Endovascular therapy
Thrombectomy
topic Ischemic stroke
Cerebral edema
Endovascular therapy
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 (∆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.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
AM
http://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/311277
https://dx.doi.org/urn:doi:10.1136/jnis-2024-021641
url https://ddd.uab.cat/record/311277
https://dx.doi.org/urn:doi:10.1136/jnis-2024-021641
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI19/00859
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://rightsstatements.org/vocab/InC/1.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://rightsstatements.org/vocab/InC/1.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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