Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome
Por:
Guasch-Jiménez, M, Dhar, R, Kumar, A, Cifarelli, J, Ezcurra-Díaz, G, Lambea-Gil, A, Ramos-Pachón, A, Martínez-Domeño, A, Prats-Sánchez, L, Guisado-Alonso, D, Fernández-Cadenas, I, Aguilera-Simón, A, Marín, R, Martínez-González, J, Ortega-Quintanilla, J, Fernández-Pérez,I, Avellaneda-Gómez, C, Rodríguez-Pardo, J, de Celis, E, Moniche, F, Freijo, M, Cortijo, E, Trillo, S, Camps-Renom, P, Martí-Fábregas , J
Publicada:
1 abr 2025
Ahead of Print:
1 abr 2024
Aceptada:
2 abr 2024
Resumen:
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 ( increment 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 increment 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. increment 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 increment CSF, was associated with worse outcomes.
Filiaciones:
Guasch-Jiménez, M:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Dhar, R:
Washington Univ, Sch Med, Neurol, St Louis, MO USA
Kumar, A:
Washington Univ, Sch Med, Neurol, St Louis, MO USA
Cifarelli, J:
Washington Univ, Sch Med, Neurol, St Louis, MO USA
Ezcurra-Díaz, G:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Lambea-Gil, A:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Ramos-Pachón, A:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Martínez-Domeño, A:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Prats-Sánchez, L:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Guisado-Alonso, D:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Fernández-Cadenas, I:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Aguilera-Simón, A:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Marín, R:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Martínez-González, J:
Hosp Santa Creu & Sant Pau, Neurointervent Radiol, Barcelona, Spain
Ortega-Quintanilla, J:
Virgen del Rocio Univ Hosp, Neurointervent Radiol, Seville, Spain
Fernández-Pérez,I:
Hosp del Mar, Neurol, Barcelona, Spain
Avellaneda-Gómez, C:
Hosp del Mar, Neurol, Barcelona, Spain
Rodríguez-Pardo, J:
La Paz Univ Hosp, Neurol, Madrid, Spain
de Celis, E:
La Paz Univ Hosp, Neurol, Madrid, Spain
Moniche, F:
Hosp Univ Virgen del Rocio, Neurol, Seville, Spain
Freijo, M:
Cruces Univ Hosp, Neurol, Baracaldo, Spain
Cortijo, E:
Valladolid Univ Hosp, Neurol, Valladolid, Spain
Trillo, S:
Hosp Univ La Princesa, Neurol, Madrid, Spain
Camps-Renom, P:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
Martí-Fábregas , J:
Hosp Santa Creu & Sant Pau, Neurol, Barcelona 08025, Spain
Inst Recerca St Pau IIB St PAU, Stroke Unit, Barcelona, Spain
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