Cerebral Edema Progression and Outcomes in Large Infarct Patients Undergoing Endovascular Thrombectomy
Ximing Nie MD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
These authors contributed equally to this work.
Search for more papers by this authorJinjie Liu MD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Department of General Medicine, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), Dalian, China
These authors contributed equally to this work.
Search for more papers by this authorBernard Yan DMedSci
Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
Search for more papers by this authorFelix C. Ng MBBS
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
Department of Neurology, Austin Health, Heidelberg, Australia
Search for more papers by this authorSibo Liu MD
Department of Intensive Care Unit, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), Dalian, China
These authors contributed equally to this work.
Search for more papers by this authorYongle Wang MD
Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
Search for more papers by this authorMengxing Wang PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorLina Zheng MD, PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorZan Wang MD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorYuying Wang MD
School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China
Search for more papers by this authorYuesong Pan PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorXiaochuan Huo MD, PhD
Neurological Disease Center, Cerebral Vascular Disease Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorZhongrong Miao MD, PhD
Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorStephen M. Davis MD
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
Search for more papers by this authorCorresponding Author
Liping Liu MD, PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Address correspondence to Dr Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing 100070, China. E-mail: [email protected]
Search for more papers by this authorfor the ANGEL-ASPECT Study Group
Search for more papers by this authorXiming Nie MD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
These authors contributed equally to this work.
Search for more papers by this authorJinjie Liu MD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Department of General Medicine, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), Dalian, China
These authors contributed equally to this work.
Search for more papers by this authorBernard Yan DMedSci
Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
Search for more papers by this authorFelix C. Ng MBBS
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
Department of Neurology, Austin Health, Heidelberg, Australia
Search for more papers by this authorSibo Liu MD
Department of Intensive Care Unit, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), Dalian, China
These authors contributed equally to this work.
Search for more papers by this authorYongle Wang MD
Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
Search for more papers by this authorMengxing Wang PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorLina Zheng MD, PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorZan Wang MD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorYuying Wang MD
School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China
Search for more papers by this authorYuesong Pan PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Search for more papers by this authorXiaochuan Huo MD, PhD
Neurological Disease Center, Cerebral Vascular Disease Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorZhongrong Miao MD, PhD
Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorStephen M. Davis MD
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
Search for more papers by this authorCorresponding Author
Liping Liu MD, PhD
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
China National Clinical Research Center for Neurological Diseases, Beijing, China
Address correspondence to Dr Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing 100070, China. E-mail: [email protected]
Search for more papers by this authorfor the ANGEL-ASPECT Study Group
Search for more papers by this authorThe ANGEL-ASPECT Study Group members are listed in online supplementary file (Data S4).
ClinicalTrials.gov Identifier: NCT04551664.
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;98:258–269
Potential Conflicts of Interest
Nothing to report.
Open Research
Data Availability
The data that support the findings of this study are available from the corresponding author on reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| ana27235-sup-0001-Supplement1.pdfPDF document, 964.7 KB | Data S1. Supporting Information. |
| ana27235-sup-0002-Supplement2.docxWord 2007 document , 239.3 KB | Data S2. Supporting Information. |
| ana27235-sup-0003-Supplement3.docxWord 2007 document , 61 KB | Data S3. Supporting Information. |
| ana27235-sup-0004-Supplement4.docxWord 2007 document , 19 KB | Data S4. Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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