机械取栓后恶性脑水肿的风险和结局：前循环闭塞的急性缺血性脑卒中。
The risk and outcome of malignant brain edema in post-mechanical thrombectomy: acute ischemic stroke by anterior circulation occlusion.
机构信息
Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China.
Department of Radiology, Shanxi Fenyang Hospital, Shanxi, China.
出版信息
Eur J Med Res. 2023 Oct 13;28(1):435. doi: 10.1186/s40001-023-01414-x.
BACKGROUND AND PURPOSE
Malignant brain edema (MBE) occurring after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) could lead to severe disability and mortality. We aimed to investigate the incidence, predictors, and clinical outcomes of MBE in patients with AIS after MT.
METHODS
The clinical and imaging data of 155 patients with AIS of anterior circulation after MT were studied. Standard non-contrast CT was used to evaluate baseline imaging characteristics at admission. Clinical outcomes were measured using the 90-day modified Rankin Scale (mRS) score. Based on the follow-up CT scans performed within 72 h after MT, the patients were classified into MBE and non-MBE group. MBE was defined as a midline shift of ≥ 5 mm with signs of local brain swelling. Univariate and multivariate regression analyses were used to analyze the relationship between MBE and clinical outcomes and identify the predictors that correlate with MBE.
RESULTS
MBE was observed in 19.4% of the patients who underwent MT and was associated with a lower rate of favorable 90-day clinical outcomes. Significant differences were observed in both MBE and non-MBE groups: baseline Alberta Stroke Program Early CT (ASPECT) score, hyperdense middle cerebral artery sign (HMCAS), baseline signs of early infarct, angiographic favorable collaterals, number of retrieval attempts, and revascularization rate. Multivariate analysis indicated that low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count, and poor revascularization independently influenced the occurrence of MBE in AIS patients with anterior circulation after MT.
CONCLUSION
MBE was associated with a lower rate of favorable 90-day clinical outcomes. Low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count and poor revascularization were independently associated with MBE after MT.
背景与目的
机械取栓（MT）后发生的恶性脑水肿（MBE）可导致急性缺血性脑卒中（AIS）患者严重残疾和死亡。我们旨在探讨 MT 后 AIS 患者 MBE 的发生率、预测因素和临床结局。
方法
研究了 155 例前循环 AIS 患者 MT 后的临床和影像学数据。入院时采用标准非对比 CT 评估基线影像学特征。采用 90 天改良 Rankin 量表（mRS）评分评估临床结局。根据 MT 后 72 小时内进行的随访 CT 扫描，将患者分为 MBE 和非 MBE 组。MBE 定义为中线移位≥5mm 并伴有局部脑肿胀迹象。采用单因素和多因素回归分析，分析 MBE 与临床结局的关系，并确定与 MBE 相关的预测因素。
结果
19.4%的 MT 患者发生 MBE，与 90 天临床结局良好率较低相关。MBE 组和非 MBE 组之间存在显著差异：基线 Alberta 卒中项目早期 CT（ASPECT）评分、高密度大脑中动脉征（HMCAS）、基线早期梗死征象、血管造影良好的侧支循环、取栓尝试次数和再通率。多因素分析表明，基线 ASPECT 评分低、无 HMCAS、血管造影侧支循环差、取栓尝试次数多和再通率差独立影响 MT 后前循环 AIS 患者 MBE 的发生。
结论
MBE 与 90 天临床结局良好率较低相关。基线 ASPECT 评分低、无 HMCAS、血管造影侧支循环差、取栓尝试次数多和再通率差与 MT 后 MBE 独立相关。
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