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

Pu, Mingjun; Chen, Zhonglun; Li, Zhaokun; Li, Zuo-Qiao; Tang, Yufeng; Li, Qi

doi:10.1016/j.jstrokecerebrovasdis.2023.107139

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…At a mean time of 92 min from groin puncture to recanalization TICI2b, the mean interventional treatment time was longer than treating an intracranial vessel occlusion alone, and nearly twice as long as in a 2016 meta-analysis on thrombectomy covering 1287 patients [ 20 ]. In this meta-analysis, a longer time to reperfusion was found to increase the risk of a worse outcome, congruent with other more recent studies on thrombectomy in purely intracranial vessel occlusion [ 15 , 21 , 22 ].…”

Section: Discussionsupporting

confidence: 90%

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Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

Khanafer,

Henkes,

Bücke

et al. 2024

BMC Neurol

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Background Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities. Methods Patients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected. Results 176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome. Conclusion In our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.

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Section: Discussionsupporting

confidence: 90%

“…Extracranial stent patency at 24 h correlates with a better clinical outcome, and intravenous thrombolytic therapy accompanying thrombectomy was found to have a positive influence on stent patency. Recent studies advocate an aggressive APT in the initial phase to keep the stent open [ 7 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

Khanafer,

Henkes,

Bücke

et al. 2024

BMC Neurol

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“…As one of the serious complications in acute ischemic stroke patients after EVT treatment, MBE might lead to a higher rate of functional dependence mortality at 90 days [5][6][7][8]. Davoli et al analyzed patients from a prospective single-center database and found that in patients with large intracranial vessel occlusions undergoing EVT, 35.7% of patients developed malignant middle cerebral artery infarction [25].…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular thrombectomy (EVT) has been recognized as the standard treatment for large vessel occlusion strokes in the anterior cerebral circulation [2][3][4]. The common complication after EVT is malignant brain edema (MBE), which increases the risk of functional dependence and reduces the beneficial effect of EVT treatment [5][6][7][8]. Hence, determining the predictors of MBE may help in understanding the underlying mechanisms and prompting early identification of patients at risk for brain edema after EVT.…”

Section: Introductionmentioning

confidence: 99%

Higher Serum E-Selectin Levels Associated with Malignant Brain Edema after Endovascular Thrombectomy for Ischemic Stroke: A Pilot Study

Zhou

et al. 2023

Brain Sciences

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Background and Purpose: Little is known about the effect of soluble adhesion molecules on malignant brain edema (MBE) after endovascular thrombectomy (EVT). This study aimed to explore the association between serum concentrations of E-selectin and the risk of MBE in patients who received EVT. Methods: Patients with a large vessel occlusion stroke in the anterior circulation who underwent EVT were prospectively recruited. Serum soluble E-selectin concentrations were measured after admission for all patients. MBE was defined as a midline shift of ≥5 mm on follow-up imaging within 72 h after surgery. Multivariate logistic regression analyses were performed to determine the association between E-selectin levels and the risk of MBE. Results: Among the 261 included patients (mean age, 69.7 ± 12.3 years; 166 males), 59 (22.6%) developed MBE. Increasing circulating E-selectin levels were associated with an increased risk of MBE after multivariable adjustment (odds ratios [OR], highest vs. lowest quartile: 3.593; 95% confidence interval [CI], 1.178−10.956; p = 0.025). We further observed a significantly positive association between E-selectin and MBE (per 1-standard deviation increase; OR, 1.988; 95% CI, 1.379−2.866, p = 0.001) when the E-selectin levels were analyzed as a continuous variable. Furthermore, the restricted cubic spline demonstrated a linear correlation between serum E-selectin levels and the risk of MBE (p < 0.001 for linearity). Conclusions: In this prospective study, circulating levels of E-selectin were associated with an increased risk of MBE after EVT. Further mechanistic studies are warranted to elucidate the pathophysiology underlying this association.

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Nomogram to Predict 90-Day All-Cause Mortality in Acute Ischemic Stroke Patients after Endovascular Thrombectomy

Zhang,

Yu,

Wang

et al. 2024

CNR

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Objective: Although Endovascular Thrombectomy (EVT) significantly improves the prognosis of Acute Ischemic Stroke (AIS) patients with large vessel occlusion, the mortality rate remains higher. This study aimed to construct and validate a nomogram for predicting 90-day all-cause mortality in AIS patients with large vessel occlusion and who have undergone EVT. Methods: AIS patients with large vessel occlusion in the anterior circulation who underwent EVT from May 2017 to December 2022 were included. 430 patients were randomly split into a training group (N=302) and a test group (N=128) for the construction and validation of our nomogram. In the training group, multivariate logistic regression analysis was performed to determine the predictors of 90-day all-cause mortality. The C-index, calibration plots, and decision curve analysis were applied to evaluate the nomogram performance. Results: Multivariate logistic regression analysis revealed neurological deterioration during hospitalization, age, baseline National Institutes of Health Stroke Scale (NIHSS) score, occlusive vessel location, malignant brain edema, and Neutrophil-to-lymphocyte Ratio (NLR) as the independent predictors of 90-day all-cause mortality (all p ≤ 0.039). The C-index of the training and test groups was 0.891 (95%CI 0.848-0.934) and 0.916 (95% CI: 0.865-0.937), respectively, showing the nomogram to be well distinguished. The Hosmer-Lemeshow goodness-of-fit test revealed the p-values for both the internal and external verification datasets to be greater than 0.5. Conclusion: Our nomogram has incorporated relevant clinical and imaging features, including neurological deterioration, age, baseline NIHSS score, occlusive vessel location, malignant brain edema, and NLR ratio, to provide an accurate and reliable prediction of 90-day all-cause mortality in AIS patients undergoing EVT.

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

Cited by 4 publications

References 32 publications

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

Higher Serum E-Selectin Levels Associated with Malignant Brain Edema after Endovascular Thrombectomy for Ischemic Stroke: A Pilot Study

Nomogram to Predict 90-Day All-Cause Mortality in Acute Ischemic Stroke Patients after Endovascular Thrombectomy

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