Predictors and outcome of malignant cerebral edema after successful reperfusion in anterior circulation stroke

作者全名："Pu, Mingjun; Chen, Jun; Chen, Zhonglun; Li, Zhaokun; Li, Zuoqiao; Tang, Yufeng; Li, Qi"

作者地址："[Pu, Mingjun; Li, Zuoqiao; Li, Qi] Chongqing Med Univ, Affiliated Hosp 1, Dept Neurol, Chongqing 400016, Peoples R China; [Pu, Mingjun; Chen, Jun; Chen, Zhonglun; Li, Zhaokun; Tang, Yufeng] Univ Elect Sci & Technol China, Mianyang Cent Hosp, Sch Med, Mianyang 621000, Peoples R China"

通信作者："Li, Q (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Neurol, Chongqing 400016, Peoples R China."

来源：JOURNAL OF STROKE & CEREBROVASCULAR DISEASES

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000990520200001

JCR分区：Q3

影响因子：2

年份：2023

卷号：32

期号：6

开始页：　

结束页：　

文献类型：Article

关键词：Endovascular thrombectomy; Successful reperfusion; Malignant cerebral edema; Predictor

摘要："Background and objective: Risk factors and predictors of malignant cerebral edema (MCE) after successful endovascular thrombectomy (EVT) were not fully explored. This study aimed to evaluate the incidence and risk factors of MCE after successful reperfusion. Methods: We retrospectively analyzed consecutive ischemic stroke patients who underwent EVT in our institution from November 2015 to April 2022. Patients who failed to achieve successful reperfusion (modified thrombolysis in cerebral infarction [mTICI]<2b) were excluded. Based on multivariate logistic mod-els, the best -fit monogram was established. The discriminative performance was assessed by the receiver operating characteristics curve (ROC). Results: A total of 307 patients were included and 48 (15.6%) were diagnosed with MCE after success-ful reperfusion. Patients with MCE after successful reperfusion had a lower 3 -month favorable outcome (15.2% versus 59.6%; p<0.001), a lower 3-month good outcome (17.4% versus 68.4%; p<0.001), and a higher rate of mortality at 3-month (54.3% versus 8.8%; p<0.001) compared with patients without MCE. Predictors of MCE after successful reperfusion included admission glucose level, baseline National Institutes of Health Stroke Scale (NIHSS) score, stroke etiology, occlusion site and puncture-to-reperfusion (PTR) time>120 min. The area under the curve (AUC) of the nomogram was 0.805 (95% CI, 0.756-0.847). Conclusions: MCE after successful reperfusion is associated with poor outcome and mortality. A nomogram containing admission glucose level, baseline NIHSS score, stroke etiology, occlusion site and PTR time>120 min may predict the risk of MCE after successful reperfusion in patients with acute ischemic stroke and treated successfully with EVT."

基金机构：Excellent Youth Founda-tion of Chongqing Scientific Committee [cstc2021jcyj-jqX0029]; Primary Health Development Research Center of Sichuan Province Program [SWFZ21-Q-55]; Sichuan Medical Association [S21023]

基金资助正文："This study was supported by the Excellent Youth Founda-tion of Chongqing Scientific Committee (cstc2021jcyj-jqX0029) , The Primary Health Development Research Center of Sichuan Province Program (SWFZ21-Q-55) , Sichuan Medical Association (S21023) ."