Cerebral Edema Progression and Outcomes in Large Infarct Patients Undergoing Endovascular Thrombectomy.

IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY
Ximing Nie, Jinjie Liu, Bernard Yan, Felix C Ng, Sibo Liu, Yongle Wang, Mengxing Wang, Lina Zheng, Zan Wang, Yuying Wang, Yuesong Pan, Xiaochuan Huo, Zhongrong Miao, Stephen M Davis, Liping Liu
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Abstract

Objective: The goal was to analyze the progression of cerebral edema post-endovascular thrombectomy (EVT) in large infarcts and its association with functional outcomes.

Methods: A secondary analysis of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core trial was conducted in patients with large ischemic cores randomized to receive either EVT or medical management (MM) alone. Patients who had follow-up imaging within 7 days post-randomization were involved. The primary outcome was midline shift (MLS). Mediation analysis was performed with EVT as the independent variable, MLS as the mediator, and modified Rankin scale scores at 90 days served as the endpoint. An exploratory analysis was conducted on the progression of net water uptake (ΔNWU).

Results: Of 434 patients, median age was 66.0 years (standard deviation [SD], 9.9), with 61.3% (266) being males. EVT was associated with an early increase in MLS at 24 (±12) hours after randomization (mean [SD], 3.0 [4.2] vs 2.4 [3.6]mm; p = 0.03) compared with the MM group, partially mediating poorer functional outcomes post-EVT (mediation proportion, -25%; 95% CI, -46.54 to -4.10), but did not negate the overall efficacy of thrombectomy. The progression of NWU remained slower after EVT throughout 7 days, inconsistent with MLS.

Interpretation: In patients with large infarct cores, EVT was associated with an early increased mass effect compared with MM, potentially mediating poorer functional outcomes. Despite the evident overall benefits from thrombectomy, accurate prediction and effective anti-edema interventions for the early mass effect post-EVT may further improve outcomes. The complex relationship between NWU and cerebral edema progression warrants further investigation. ANN NEUROL 2025.

接受血管内取栓术的大梗死患者脑水肿的进展和结局。
目的:目的是分析大梗死患者血管内取栓(EVT)后脑水肿的进展及其与功能预后的关系。方法:对急性前循环大血管闭塞伴大梗死核心患者的血管内治疗进行二次分析,对大缺血核心患者随机接受EVT或单独医疗管理(MM)。随机分组后7天内进行随访影像学检查的患者。主要终点为中线移位(MLS)。以EVT为自变量,MLS为中介变量,以90天修正Rankin量表评分为终点进行中介分析。对净吸水量的进展进行了探索性分析(ΔNWU)。结果:434例患者中位年龄为66.0岁(标准差[SD], 9.9),男性占61.3%(266例)。EVT与随机分组后24(±12)小时MLS早期升高相关(平均[SD], 3.0 [4.2] vs 2.4 [3.6]mm;p = 0.03)与MM组相比,部分介导evt后较差的功能结局(中介比例-25%;95% CI, -46.54至-4.10),但没有否定取栓术的总体疗效。在EVT后的7天内,NWU的进展仍然较慢,与MLS不一致。解释:与MM相比,在大梗死核心的患者中,EVT与早期增加的质量效应相关,可能介导较差的功能结局。尽管取栓有明显的总体益处,但准确预测和有效的抗水肿干预可能会进一步改善evt后早期肿块效应。NWU与脑水肿进展之间的复杂关系值得进一步研究。Ann neurol 2025。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Neurology
Annals of Neurology 医学-临床神经学
CiteScore
18.00
自引率
1.80%
发文量
270
审稿时长
3-8 weeks
期刊介绍: Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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