O-024 Four or more thrombectomy passes, tPA use, and high initial stress glucose ratio are independently associated with malignant cerebral edema after mechanical thrombectomy: a single-center, retrospective study

G Cannarsa, A Wessell, T Chryssikos, K Kim, J Stokum, H Carvalho, T Miller, D Gandhi, G Jindal
2020 Oral Abstracts   unpublished
The development of malignant cerebral edema (MCE) after large-vessel occlusion mechanical thrombectomy (MT) with the ensuing requirement for decompressive craniectomy is a dreaded outcome of stroke. We analyzed factors associated with the development of malignant cerebral edema following mechanical thrombectomy. Methods We performed a retrospective analysis of anterior cerebral circulation large vessel occlusion cases that underwent MT from April 2012 to November 2019 at single comprehensive
more » ... le comprehensive stroke center. Data included patient demographics, presenting NIHSS score, vessel occlusion site, onset-to-revascularization timing, presenting blood glucose, 90 day modified Rankin Scale (mRS), post-procedural intracerebral hemorrhage (PH1 or PH2), and post-procedural development of MCE (midline shift greater than 5 mm associated with neurological deterioration after greater than 50% infarction of the MCA territory). Multi-variate logistic regression analyses were performed to determine significant predictors of malignant cerebral edema and poor functional outcome (mRS 3-6) at 90 days. Results 400 patients were included in the analysis. 42 (10.5%) patients developed MCE following mechanical thrombectomy with 26 (6.5%) patients undergoing decompressive craniectomy. Significant independent predictors of MCE following MT included: NIHSS (OR 1.10, 95% CI: 1.03-1.18; p=0.008), tPA administration (OR 2.38 95% CI: 1.04-5.46; p=0.041), 4 or more thrombectomy passes (OR 5.25, 95% CI: 1.53-17.94; p=0.008), and initial stress glucose ratio (OR
doi:10.1136/neurintsurg-2020-snis.24 fatcat:6gcwrfgmerblpfhzucqyv6xzlm