Abstract

BACKGROUND AND OBJECTIVE: Malignant cerebral edema (MCE) is a well-known complication in patients with acute ischemic stroke with core infarcts=80mL caused by large-vessel occlusions. MCE can also develop in patients with smaller infarcts with moderate -to-large volume of tissue at risk who do not achieve successful revascularization with endovascular thrombectomy (ET). Features that predict the development of MCE in this population are not well-described. We aim to identify predictors of MCE and 90-day functional outcome in stroke patients with an anterior circulation large vessel occlusion (LVO) and a<80mL ischemic core who do not achieve complete reperfusion.METHODS: We reviewed our institutional stroke registry and included patients who achieved unsuccessful revascularization, mTICI 0-2a, after ET and whose baseline imaging was notable for a core infarct<80mL, a Tmax>6s volume=80mL, and a mismatch ratio=1.8. MCE was defined as=5mm of midline shift on follow-up imaging, obtained 6-48h after the pre-ET perfusion scan.RESULTS: Thirty-six patients met inclusion criteria. Unadjusted analysis demonstrated that younger age, higher systolic blood pressure, larger core volume, and higher hypoperfusion intensity ratio (HIR) were associated with MCE (all p<0.02). In multivariate logistic regression analysis, age, HIR, and core infarct volume were independent predictors of MCE. The optimal HIR threshold to predict MCE was=0.54 (OR 14.7, 95% CI 2.4-78.0, p=0.003). HIR was also associated with 3-month mRS (HIR=0.54 for mRS of 3-6: OR 10.8, 95% CI 1.9-44.0, p=0.02).CONCLUSIONS: Younger age, larger core infarct volume, and higher HIR are predictive of MCE in patients with anterior circulation LVO, moderate-to-large tissue at risk, and suboptimal revascularization. HIR is correlated with three-month functional outcomes.

View details for DOI 10.1007/s12028-020-01152-6

View details for PubMedID 33200332