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Volume 21, Issue 4
  • ISSN: 1567-2026
  • E-ISSN: 1875-5739

Abstract

Objective

This study aimed to explore Malignant Brain Edema (MBE) and associated factors in patients with Large Hemispheric Infarction (LHI) following early reperfusion therapy.

Methods

We consecutively and retrospectively enrolled a cohort of 114 LHI patients who had received early reperfusion therapy, including Intravenous Thrombolysis (IVT) or Endovascular Therapy (EVT) at the hyperacute stage of stroke between January 2009 and December 2018. MBE was defined as a midline shift ≥5 mm, accompanied by signs of herniation. Multivariate logistic analyses were conducted to identify independent factors associated with MBE in LHI patients following early reperfusion therapy.

Results

Among the enrolled patients, 69 (60.53%) were treated with IVT alone and 45 (39.47%) with EVT. Successful recanalization was achieved in 56 (49.12%) patients, while complete recanalization was achieved in 38 (33.33%) patients. After early reperfusion therapy, 50 (43.86%) developed MBE in LHI patients. The MBE group showed higher rates of in-hospital death (54% . 4.69%), 3-month mortality (64% . 10.94%), and 3-month unfavorable outcomes (90% . 64.06%) (all <0.01). Neither different reperfusion therapy (EVT . IVT alone) nor different recanalization status (complete recanalization or not) was independently associated with the development of MBE in LHI patients following reperfusion therapy in multivariate analyses. MBE was independently associated with age [Odds Ratio (OR) 0.953, 95% confidence interval (CI) 0.910-0.999, =0.044], right hemisphere stroke (OR 4.051, 95% CI 1.035-15.860, =0.045), previous ischemic stroke or TIA (OR 0.090, 95% CI 0.014-0.571, =0.011), and hypodensity >1/3 MCA territory (OR 8.071, 95% CI 1.878-34.693, =0.005). Meanwhile, patients with lower baseline Alberta Stroke Program Early CT Score (ASPECTS) had a trend of higher incidence of MBE following reperfusion therapy (OR 0.710, 95% CI 0.483-1.043, =0.081).

Conclusion

MBE occurred in nearly one-half of LHI patients following early reperfusion therapy and was related to poor outcomes. An increased risk of MBE was found to be associated with younger age, right hemisphere stroke, absence of a history of ischemic stroke or TIA, and hypodensity >1/3 MCA region on baseline CT images.

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References

  1. UhlE. KrethF.W. EliasB. GoldammerA. HempelmannR.G. LiefnerM. NowakG. OertelM. SchmiederK. SchneiderG.H. Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction.J. Neurol. Neurosurg. Psychiatry200475227027414742603
     [Google Scholar]
  2. HuttnerH.B. SchwabS. Malignant middle cerebral artery infarction: Clinical characteristics, treatment strategies, and future perspectives.Lancet Neurol.200981094995810.1016/S1474‑4422(09)70224‑819747656
     [Google Scholar]
  3. HackeW. SchwabS. HornM. SprangerM. De GeorgiaM. von KummerR. ‘Malignant’ middle cerebral artery territory infarction: Clinical course and prognostic signs.Arch. Neurol.199653430931510.1001/archneur.1996.005500400370128929152
     [Google Scholar]
  4. BerrouschotJ. SterkerM. BettinS. KösterJ. SchneiderD. Mortality of space-occupying (‘malignant’) middle cerebral artery infarction under conservative intensive care.Intensive Care Med.199824662062310.1007/s0013400506259681786
     [Google Scholar]
  5. FrankJ.I. Large hemispheric infarction, deterioration, and intracranial pressure.Neurology19954571286129010.1212/WNL.45.7.12867617183
     [Google Scholar]
  6. SteinerT. RinglebP. HackeW. Treatment options for large hemispheric stroke.Neurology2001575Suppl. 2S61S6811552058
     [Google Scholar]
  7. VahediK. HofmeijerJ. JuettlerE. VicautE. GeorgeB. AlgraA. AmelinkG.J. SchmiedeckP. SchwabS. RothwellP.M. BousserM.G. van der WorpH.B. HackeW. DECIMAL, DESTINY, and HAMLET investigators Early decompressive surgery in malignant infarction of the middle cerebral artery: A pooled analysis of three randomised controlled trials.Lancet Neurol.20076321522210.1016/S1474‑4422(07)70036‑417303527
     [Google Scholar]
  8. WardlawJ.M. MurrayV. BergeE. del ZoppoG. SandercockP. LindleyR.L. CohenG. Recombinant tissue plasminogen activator for acute ischaemic stroke: An updated systematic review and meta-analysis.Lancet201237998342364237210.1016/S0140‑6736(12)60738‑722632907
     [Google Scholar]
  9. KogaM. ArihiroS. MiyashitaF. YamamotoH. YamadaN. NagatsukaK. MinematsuK. ToyodaK. Factors associated with early recanalization failure following intravenous rt-PA therapy for ischemic stroke.Cerebrovasc. Dis.201336429930510.1159/00035505424135558
     [Google Scholar]
  10. SenersP. TurcG. MaïerB. MasJ.L. OppenheimC. BaronJ.C. Incidence and predictors of early recanalization after intravenous thrombolysis: A systematic review and meta-analysis.Stroke20164792409241210.1161/STROKEAHA.116.01418127462117
     [Google Scholar]
  11. GoyalM. MenonB.K. van ZwamW.H. DippelD.W.J. MitchellP.J. DemchukA.M. DávalosA. MajoieC.B.L.M. van der LugtA. de MiquelM.A. DonnanG.A. RoosY.B.W.E.M. BonafeA. JahanR. DienerH.C. van den BergL.A. LevyE.I. BerkhemerO.A. PereiraV.M. RempelJ. MillánM. DavisS.M. RoyD. ThorntonJ. RománL.S. RibóM. BeumerD. StouchB. BrownS. CampbellB.C.V. van OostenbruggeR.J. SaverJ.L. HillM.D. JovinT.G. HERMES collaborators Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials.Lancet2016387100291723173110.1016/S0140‑6736(16)00163‑X26898852
     [Google Scholar]
  12. NogueiraR.G. JadhavA.P. HaussenD.C. BonafeA. BudzikR.F. BhuvaP. YavagalD.R. RiboM. CognardC. HanelR.A. SilaC.A. HassanA.E. MillanM. LevyE.I. MitchellP. ChenM. EnglishJ.D. ShahQ.A. SilverF.L. PereiraV.M. MehtaB.P. BaxterB.W. AbrahamM.G. CardonaP. VeznedarogluE. HellingerF.R. FengL. KirmaniJ.F. LopesD.K. JankowitzB.T. FrankelM.R. CostalatV. VoraN.A. YooA.J. MalikA.M. FurlanA.J. RubieraM. AghaebrahimA. OlivotJ.M. TekleW.G. ShieldsR. GravesT. LewisR.J. SmithW.S. LiebeskindD.S. SaverJ.L. JovinT.G. DAWN Trial Investigators Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct.N. Engl. J. Med.20183781112110.1056/NEJMoa170644229129157
     [Google Scholar]
  13. AlbersG.W. MarksM.P. KempS. ChristensenS. TsaiJ.P. Ortega-GutierrezS. McTaggartR.A. TorbeyM.T. Kim-TenserM. Leslie-MazwiT. SarrajA. KasnerS.E. AnsariS.A. YeattsS.D. HamiltonS. MlynashM. HeitJ.J. ZaharchukG. KimS. CarrozzellaJ. PaleschY.Y. DemchukA.M. BammerR. LavoriP.W. BroderickJ.P. LansbergM.G. DEFUSE 3 Investigators Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging.N. Engl. J. Med.2018378870871810.1056/NEJMoa171397329364767
     [Google Scholar]
  14. BellwaldS. WeberR. DobrockyT. NordmeyerH. JungS. HadisuryaJ. MordasiniP. MonoM.L. StrackeC.P. SarikayaH. BernasconiC. BergerK. ArnoldM. ChapotR. GrallaJ. FischerU. Direct mechanical intervention versus bridging therapy in stroke patients eligible for intravenous thrombolysis: A pooled analysis of 2 registries.Stroke201748123282328810.1161/STROKEAHA.117.01845929114095
     [Google Scholar]
  15. CoutinhoJ.M. LiebeskindD.S. SlaterL.A. NogueiraR.G. ClarkW. DávalosA. BonaféA. JahanR. FischerU. GrallaJ. SaverJ.L. PereiraV.M. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: A pooled analysis of the SWIFT and STAR studies.JAMA Neurol.201774326827410.1001/jamaneurol.2016.537428097310
     [Google Scholar]
  16. KaesmacherJ. MordasiniP. ArnoldM. López-CancioE. CerdáN. Boeckh-BehrensT. KleineJ.F. GoyalM. HillM.D. PereiraV.M. SaverJ.L. GrallaJ. FischerU. Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: A meta-analysis.J. Neurointerv. Surg.2019111202710.1136/neurintsurg‑2018‑01383429705773
     [Google Scholar]
  17. YangP. ZhangY. ZhangL. ZhangY. TreurnietK.M. ChenW. PengY. HanH. WangJ. WangS. YinC. LiuS. WangP. FangQ. ShiH. YangJ. WenC. LiC. JiangC. SunJ. YueX. LouM. ZhangM. ShuH. SunD. LiangH. LiT. GuoF. KeK. YuanH. WangG. YangW. ShiH. LiT. LiZ. XingP. ZhangP. ZhouY. WangH. XuY. HuangQ. WuT. ZhaoR. LiQ. FangY. WangL. LuJ. LiY. FuJ. ZhongX. WangY. WangL. GoyalM. DippelD.W.J. HongB. DengB. RoosY.B.W.E.M. MajoieC.B.L.M. LiuJ. DIRECT-MT Investigators Endovascular thrombectomy with or without intravenous alteplase in acute stroke.N. Engl. J. Med.2020382211981199310.1056/NEJMoa200112332374959
     [Google Scholar]
  18. shimoyamaT. The Dash score: A simple score to assess risk for development of malignant middle cerebral artery infarction.J. Neurol. Sci.2014338102106
     [Google Scholar]
  19. KimH. Predictors of malignant brain edema in middle cerebral artery infarction observed on cT angiography.J. Clin. Neurosci.201522554560
     [Google Scholar]
  20. HorschAD. Imaging findings associated with space-occupying edema in patients with large middle cerebral artery infarcts.AJNR Am. J. Neuroradiol.201637831837
     [Google Scholar]
  21. HofmeijerJ. AlgraA. KappelleL.J. van der WorpH.B. Predictors of life-threatening brain edema in middle cerebral artery infarction.Cerebrovasc. Dis.2008251-217618410.1159/00011373618212524
     [Google Scholar]
  22. WuS. YuanR. WangY. WeiC. ZhangS. YangX. WuB. LiuM. Early prediction of malignant brain edema after ischemic stroke.Stroke201849122918292710.1161/STROKEAHA.118.02200130571414
     [Google Scholar]
  23. HuangX. YangQ. ShiX. XuX. GeL. DingX. ZhouZ. Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke.J. Neurointerv. Surg.2019111099499810.1136/neurintsurg‑2018‑01465030798266
     [Google Scholar]
  24. KongF.Y. TaoW.D. HaoZ.L. LiuM. Predictors of one-year disability and death in Chinese hospitalized women after ischemic stroke.Cerebrovasc. Dis.201029325526210.1159/00026785220029199
     [Google Scholar]
  25. LeiC. WuB. LiuM. ChenY. YangH. WangD. LinS. HaoZ. Totaled health risks in vascular events score predicts clinical outcomes in patients with cardioembolic and other subtypes of ischemic stroke.Stroke20144561689169410.1161/STROKEAHA.113.00435224743443
     [Google Scholar]
  26. de HaanR. LimburgM. BossuytP. van der MeulenJ. AaronsonN. The clinical meaning of Rankin ‘handicap’ grades after stroke.Stroke199526112027203010.1161/01.STR.26.11.20277482643
     [Google Scholar]
  27. AdamsH.P.Jr BendixenB.H. KappelleL.J. BillerJ. LoveB.B. GordonD.L. MarshE.E.III Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment.Stroke1993241354110.1161/01.STR.24.1.357678184
     [Google Scholar]
  28. TopcuogluM.A. ArsavaE.M. KursunO. AkpinarE. ErbilB. The utility of middle cerebral artery clot density and burden assessment by noncontrast computed tomography in acute ischemic stroke patients treated with thrombolysis.J. Stroke Cerebrovasc. Dis.2014232e85e9110.1016/j.jstrokecerebrovasdis.2013.08.02624119367
     [Google Scholar]
  29. KalafutM.A. SchrigerD.L. SaverJ.L. StarkmanS. Detection of early CT signs of >1/3 middle cerebral artery infarctions : Interrater reliability and sensitivity of CT interpretation by physicians involved in acute stroke care.Stroke20003171667167110.1161/01.STR.31.7.166710884471
     [Google Scholar]
  30. PexmanJ.H.W. BarberP.A. HillM.D. SevickR.J. DemchukA.M. HudonM.E. HuW.Y. BuchanA.M. Use of the alberta stroke program early CT score (ASPECTS) for assessing CT scans in patients with acute stroke.AJNR Am. J. Neuroradiol.20012281534154211559501
     [Google Scholar]
  31. ZaidatO.O. YooA.J. KhatriP. TomsickT.A. von KummerR. SaverJ.L. MarksM.P. PrabhakaranS. KallmesD.F. FitzsimmonsB.F.M. MoccoJ. WardlawJ.M. BarnwellS.L. JovinT.G. LinfanteI. SiddiquiA.H. AlexanderM.J. HirschJ.A. WintermarkM. AlbersG. WooH.H. HeckD.V. LevM. AvivR. HackeW. WarachS. BroderickJ. DerdeynC.P. FurlanA. NogueiraR.G. YavagalD.R. GoyalM. DemchukA.M. BendszusM. LiebeskindD.S. Cerebral Angiographic Revascularization Grading (CARG) Collaborators STIR Revascularization working group STIR Thrombolysis in Cerebral Infarction (TICI) Task Force Recommendations on angiographic revascularization grading standards for acute ischemic stroke: A consensus statement.Stroke20134492650266310.1161/STROKEAHA.113.00197223920012
     [Google Scholar]
  32. OspelJ M SinghN AlmekhlafiM A Early recanalization with alteplase in stroke because of large vessel occlusion in the escape trial.Stroke2020521304307
     [Google Scholar]
  33. KimberlyW.T. DutraB.G. BoersA.M.M. AlvesH.C.B.R. BerkhemerO.A. van den BergL. ShethK.N. RoosY.B.W.E.M. van der LugtA. BeenenL.F.M. DippelD.W.J. van ZwamW.H. van OostenbruggeR.J. LingsmaH.F. MarqueringH. MajoieC.B.L.M. MR CLEAN Investigators Association of reperfusion with brain edema in patients with acute ischemic stroke.JAMA Neurol.201875445346110.1001/jamaneurol.2017.516229365017
     [Google Scholar]
  34. HackeW. KasteM. FieschiC. von KummerR. DavalosA. MeierD. LarrueV. BluhmkiE. DavisS. DonnanG. SchneiderD. Diez-TejedorE. TrouillasP. Second European-Australasian Acute Stroke Study Investigators Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II).Lancet199835291361245125110.1016/S0140‑6736(98)08020‑99788453
     [Google Scholar]
  35. JauchE.C. SaverJ.L. AdamsH.P.Jr BrunoA. ConnorsJ.J.B. DemaerschalkB.M. KhatriP. McMullanP.W.Jr QureshiA.I. RosenfieldK. ScottP.A. SummersD.R. WangD.Z. WintermarkM. YonasH. American Heart Association Stroke Council Council on Cardiovascular Nursing Council on Peripheral Vascular Disease Council on Clinical Cardiology Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association.Stroke201344387094710.1161/STR.0b013e318284056a23370205
     [Google Scholar]
  36. WilliamJ. ColinP. JoséB. 2015 american heart association/american stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment A guideline for healthcare professionals from the American H.Int. J. Cerebrovasc. Dis.20152311801814
     [Google Scholar]
  37. JohnstonK.C. LiJ.Y. LydenP.D. HansonS.K. FeasbyT.E. AdamsR.J. FaughtR.E.Jr HaleyE.C.Jr RANTTAS Investigators Medical and neurological complications of ischemic stroke: Experience from the RANTTAS trial.Stroke199829244745310.1161/01.STR.29.2.4479472888
     [Google Scholar]
  38. HackeW. KasteM. BluhmkiE. BrozmanM. DávalosA. GuidettiD. LarrueV. LeesK.R. MedeghriZ. MachnigT. SchneiderD. von KummerR. WahlgrenN. ToniD. ECASS Investigators Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.N. Engl. J. Med.2008359131317132910.1056/NEJMoa080465618815396
     [Google Scholar]
  39. ThomallaG. SimonsenC.Z. BoutitieF. AndersenG. BerthezeneY. ChengB. CheripelliB. ChoT.H. FazekasF. FiehlerJ. FordI. GalinovicI. GellissenS. GolsariA. GregoriJ. GüntherM. GuibernauJ. HäuslerK.G. HennericiM. KemmlingA. MarstrandJ. ModrauB. NeebL. Perez de la OssaN. PuigJ. RinglebP. RoyP. ScheelE. SchonewilleW. SerenaJ. SunaertS. VillringerK. WoutersA. ThijsV. EbingerM. EndresM. FiebachJ.B. LemmensR. MuirK.W. NighoghossianN. PedrazaS. GerloffC. WAKE-UP Investigators MRI-guided thrombolysis for stroke with unknown time of onset.N. Engl. J. Med.2018379761162210.1056/NEJMoa180435529766770
     [Google Scholar]
  40. StrbianD. MeretojaA. PutaalaJ. KasteM. TatlisumakT. Helsinki Stroke Thrombolysis Registry Group Cerebral edema in acute ischemic stroke patients treated with intravenous thrombolysis.Int. J. Stroke20138752953410.1111/j.1747‑4949.2012.00781.x22405327
     [Google Scholar]
  41. ThorénM. AzevedoE. DawsonJ. EgidoJ.A. FalcouA. FordG.A. HolminS. MikulikR. OllikainenJ. WahlgrenN. AhmedN. Predictors for cerebral edema in acute ischemic stroke treated with intravenous thrombolysis.Stroke20174892464247110.1161/STROKEAHA.117.01822328775140
     [Google Scholar]
  42. DavoliA. MottaC. KochG. DiomediM. NapolitanoS. GiordanoA. PanellaM. MorosettiD. FabianoS. FlorisR. GandiniR. SallustioF. Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy.J. Neurointerv. Surg.201810434034410.1136/neurintsurg‑2017‑01322428798267
     [Google Scholar]
  43. TracolC. VannierS. HurelC. TuffierS. EugeneF. Le ResteP.J. Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy.Rev. Neurol.20201767-861962510.1016/j.neurol.2020.01.35232624178
     [Google Scholar]
  44. IrvineH.J. OstwaldtA.C. BeversM.B. DixonS. BatteyT.W.K. CampbellB.C.V. DavisS.M. DonnanG.A. ShethK.N. JahanR. SaverJ.L. KidwellC.S. KimberlyW.T. Reperfusion after ischemic stroke is associated with reduced brain edema.J. Cereb. Blood Flow Metab.201838101807181710.1177/0271678X1772055928731381
     [Google Scholar]
  45. GartshoreG. PattersonJ. MacraeI.M. Influence of ischemia and reperfusion on the course of brain tissue swelling and blood-brain barrier permeability in a rodent model of transient focal cerebral ischemia.Exp. Neurol.1997147235336010.1006/exnr.1997.66359344560
     [Google Scholar]
  46. PillaiD.R. DittmarM.S. BaldaranovD. HeidemannR.M. HenningE.C. SchuiererG. BogdahnU. SchlachetzkiF. Cerebral ischemia-reperfusion injury in rats--a 3 T MRI study on biphasic blood-brain barrier opening and the dynamics of edema formation.J. Cereb. Blood Flow Metab.200929111846185510.1038/jcbfm.2009.10619654585
     [Google Scholar]
  47. SimardJ.M. KentT.A. ChenM. TarasovK.V. GerzanichV. Brain oedema in focal ischaemia: Molecular pathophysiology and theoretical implications.Lancet Neurol.20076325826810.1016/S1474‑4422(07)70055‑817303532
     [Google Scholar]
  48. CheripelliB.K. HuangX. MacIsaacR. MuirK.W. Interaction of recanalization, intracerebral hemorrhage, and cerebral edema after intravenous thrombolysis.Stroke20164771761176710.1161/STROKEAHA.116.01314227301943
     [Google Scholar]
  49. FinkJ.N. SelimM.H. KumarS. SilverB. LinfanteI. CaplanL.R. SchlaugG. Is the association of national institutes of health stroke scale scores and acute magnetic resonance imaging stroke volume equal for patients with right- and left-hemisphere ischemic stroke?Stroke200233495495810.1161/01.STR.0000013069.24300.1D11935043
     [Google Scholar]
  50. LiJ. ZhangP. LiuY. et al. Stroke lateralization in large hemisphere infarctions: Characteristics, stroke-related complications, and outcomes.Front Neurol202112774247
     [Google Scholar]
  51. RastogiV. LambD.G. WilliamsonJ.B. SteadT.S. PenumudiR. BidariS. GantiL. HeilmanK.M. HednaV.S. Hemispheric differences in malignant middle cerebral artery stroke.J. Neurol. Sci.20153531-2202710.1016/j.jns.2015.04.03625959980
     [Google Scholar]
  52. YoonB.W. MorilloC.A. CechettoD.F. HachinskiV. Cerebral hemispheric lateralization in cardiac autonomic control.Arch. Neurol.199754674174410.1001/archneur.1997.005501800550129193209
     [Google Scholar]
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Malignant Brain Edema and Associated Factors in Large Hemispheric Infarction Following Reperfusion Therapy
Curr Neurovasc Res 21, 511 (2024); https://doi.org/10.2174/0115672026363146241216075333
/content/journals/cnr/10.2174/0115672026363146241216075333
/content/journals/cnr/10.2174/0115672026363146241216075333
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  • Article Type:     Research Article
Keyword(s): decompressive hemicraniectomy; early reperfusion therapy; endovascular interventions; intravenous thrombolysis; Large hemispheric infarction; malignant brain edema

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