Risk factors of malignant cerebral edema after mechanical thrombectomy in acute ischemic stroke
ZHANG Xiaoqin1, LUO Zhixian1, GUO Wenjun1, ZHOU Xiaojun1, XIA Nengzhi1, HONG Weifeng2.
1.Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China; 2.Department of Radiology, Yuhuan People’s Hospital, Taizhou 317600, China
ZHANG Xiaoqin,LUO Zhixian,GUO Wenjun, et al. Risk factors of malignant cerebral edema after mechanical thrombectomy in acute ischemic stroke[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2024, 54(4): 296-301.
Abstract：Objective: To investigate the risk factors of malignant cerebral edema (MCE) after mechanical thrombectomy in patients with acute ischemic stroke (AIS) and risk factors for MCE. Methods: AIS patients
who underwent mechanical thrombectomy and achieved complete vascular recanalization in the First Affiliated Hospital of Wenzhou Medical University from August 2018 to June 2022 were retrospectively collected. All patients were divided into MCE group (n=89) and non-MCE group (n=311) according to whether MCE occurred after operation. Multivariate logistic regression analysis was used to determine the independent risk factors for MCE after mechanical thrombectomy in AIS patients. Results: A total of 400 AIS patients with complete recanalization after mechanical thrombectomy were included in this study. Among them, 277 patients were males and 123 were females, aged (68.09±12.17) years. After mechanical thrombectomy, AIS patients in the MCE group had higher diastolic blood pressure than non-MCE group, with significant difference (P<0.05). At the same time, the ASPECT score of MCE group was lower than that of non-MCE group, and it is more likely to occur in the position of anterior circulation. Multivariate Logistic regression analysis showed that diastolic blood pressure (OR=1.022, 95%CI=1.005-1.039, P=0.010), ASPECT score (OR=0.742, 95%CI=0.655-0.840, P<0.001), NIHSS score (OR=1.043, 95%CI=1.004-1.083, P=0.031) and anterior circulation thrombus (OR=8.942, 95%CI=2.595- 30.816, P=0.001) were independent influencing factors for MCE. Conclusion: Preoperative low ASPECT score,high NIHSS score and anterior circulation thrombus were independent risk factors for MCE in patients with AIS after mechanical thrombectomy. The risk of MCE increases with the postoperative diastolic blood pressure. Postoperative blood pressure management, especially reducing diastolic blood pressure, may reduce the risk of MCE.
