TY - JOUR
T1 - Early automated cerebral edema assessment following endovascular therapy
T2 - impact on stroke outcome
AU - Guasch-Jiménez, Marina
AU - Dhar, Rajat
AU - Kumar, Atul
AU - Cifarelli, Julien
AU - Ezcurra-Díaz, Garbiñe
AU - Lambea-Gil, Álvaro
AU - Ramos-Pachón, Anna
AU - Martínez-Domeño, Alejandro
AU - Prats-Sánchez, Luis
AU - Guisado-Alonso, Daniel
AU - Fernández-Cadenas, Israel
AU - Aguilera-Simón, Ana
AU - Marín, Rebeca
AU - Martínez-González, José Pablo
AU - Ortega-Quintanilla, Joaquin
AU - Fernández-Pérez, Isabel
AU - Avellaneda-Gómez, Carla
AU - Rodríguez-Pardo, Jorge
AU - De Celis, Elena
AU - Moniche, Francisco
AU - Freijo, María Del Mar
AU - Cortijo, Elisa
AU - Trillo, Santiago
AU - Camps-Renom, Pol
AU - Martí-Fábregas, Joan
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024
Y1 - 2024
N2 - 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 δCSF, was associated with worse outcomes.
AB - 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 δCSF, was associated with worse outcomes.
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85191383932&partnerID=8YFLogxK
U2 - 10.1136/jnis-2024-021641
DO - 10.1136/jnis-2024-021641
M3 - Article
C2 - 38637151
AN - SCOPUS:85191383932
SN - 1759-8478
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
M1 - 021641
ER -