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Neurocritical Care
Published in: Neurocritical Care 1/2024

26-12-2023 | Edema | Original work

Association Between Hypoperfusion Intensity Ratio and Postthrombectomy Malignant Brain Edema for Acute Ischemic Stroke

Authors: Wang Chen, Xianjun Wang, Ji Liu, Mengen Wang, Shuna Yang, Lei Yang, Zixiang Gong, Wenli Hu

Published in: Neurocritical Care | Issue 1/2024

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Abstract

Background

Malignant brain edema (MBE) is a life-threatening complication that can occur after mechanical thrombectomy (MT) for acute ischemic stroke. The hypoperfusion intensity ratio (HIR) reflects the tissue-level perfusion status within the ischemic territory. This study investigated the association between HIR and MBE occurrence after MT in patients with anterior circulation large artery occlusion.

Methods

We conducted a retrospective cohort study of patients who received MT at a comprehensive stroke center from February 2020 to June 2022. Using computed tomography perfusion, the HIR was derived from the ratio of tissue volume with a time to maximum (Tmax) > 10 s to that with a Tmax > 6 s. We dichotomized patients based on the occurrence of MBE following MT. The primary outcome, assessed using a multivariable logistic regression model, was the MBE occurrence post MT. The secondary outcome focused on favorable outcomes, defined as achieving a modified Rankin Scale score of 0–2 at 90 days.

Results

Of the 603 included patients, 90 (14.9%) developed MBE after MT. The median HIR exhibited a significantly higher value in the MBE group compared with the non-MBE group (0.5 vs. 0.3; P < 0.001). Multivariable logistic regression analysis indicated that a higher HIR (adjusted odds ratio [aOR] 8.98; 95% confidence interval [CI] 2.85–28.25; P < 0.001), baseline large infarction (Alberta Stroke Program Early Computed Tomography Score < 6; aOR 1.77; 95% CI 1.04–3.01; P = 0.035), internal carotid artery occlusion (aOR 1.80; 95% CI 1.07–3.01; P = 0.028), and unsuccessful recanalization (aOR 8.45; 95% CI 4.75–15.03; P < 0.001) were independently associated with MBE post MT. Among those with successful recanalization, a higher HIR (P = 0.017) and baseline large infarction (P = 0.032) remained as predictors of MBE occurrence. Furthermore, a higher HIR (P = 0.001) and the occurrence of MBE (P < 0.001) both correlated with reduced odds of achieving favorable outcomes.

Conclusions

The presence of a higher HIR on pretreatment perfusion imaging serves as a robust predictor for MBE occurrence after MT, irrespective of successful recanalization.
Appendix
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Metadata
Title
Association Between Hypoperfusion Intensity Ratio and Postthrombectomy Malignant Brain Edema for Acute Ischemic Stroke
Authors
Wang Chen
Xianjun Wang
Ji Liu
Mengen Wang
Shuna Yang
Lei Yang
Zixiang Gong
Wenli Hu
Publication date
26-12-2023
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2024
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-023-01900-4

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