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Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment A HERMES Meta-Analysis

Authors :
Andrew M. Demchuk
Scott Brown
Tudor G Jovin
Diederik W.J. Dippel
W. Taylor Kimberly
Jeffrey L. Saver
Philip White
Serge Bracard
Gagan Sharma
Antoni Dávalos
David S Liebeskind
Mayank Goyal
Michael D. Hill
Bruce C.V. Campbell
Keith W. Muir
Nawaf Yassi
Luis San Roman
Felix C Ng
Michael J Wald
Charles B. L. M. Majoie
Kevin N. Sheth
Stephen M. Davis
Peter Mitchell
Bijoy K Menon
Francis Guillemin
Neurology
Radiology and Nuclear Medicine
ANS - Neurovascular Disorders
ACS - Microcirculation
Source :
Stroke, r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol, instname, Stroke, 52(11), 3450-3458. Lippincott Williams & Wilkins, Stroke, 3450-3458. Lippincott Williams and Wilkins, STARTPAGE=3450;ENDPAGE=3458;ISSN=0039-2499;TITLE=Stroke
Publication Year :
2021
Publisher :
Lippincott Williams & Wilkins Ltd., 2021.

Abstract

Background and Purpose: Whether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of large hemispheric infarction at baseline. Methods: In a systematic review and individual patient-level meta-analysis of 7 randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between January 1, 2010, and May 31, 2017 (Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with large hemispheric infarction on pretreatment imaging, defined as diffusion-magnetic resonance imaging or computed tomography (CT)-perfusion ischemic core 80 to 300 mL or noncontrast CT-Alberta Stroke Program Early CT Score ≤5. Risk of bias was assessed using the Cochrane tool. Results: Among 1764 patients, 177 presented with large hemispheric infarction. Thrombectomy and reperfusion were associated with functional improvement (thrombectomy common odds ratio =2.30 [95% CI, 1.32–4.00]; reperfusion common odds ratio =4.73 [95% CI, 1.66–13.52]) but not MLS (thrombectomy β=−0.27 [95% CI, −1.52 to 0.98]; reperfusion β=−0.78 [95% CI, −3.07 to 1.50]) when adjusting for age, National Institutes of Health Stroke Score, glucose, and time-to-follow-up imaging. In an exploratory analysis of patients presenting with core volume >130 mL or CT-Alberta Stroke Program Early CT Score ≤3 (n=76), thrombectomy was associated with greater MLS after adjusting for age and National Institutes of Health Stroke Score (β=2.76 [95% CI, 0.33–5.20]) but not functional improvement (odds ratio, 1.71 [95% CI, 0.24–12.08]). Conclusions: In patients presenting with large hemispheric infarction, thrombectomy and reperfusion were not associated with MLS, except in the subgroup with very large core volume (>130 mL) in whom thrombectomy was associated with increased MLS due to space-occupying ischemic edema. Mitigating cerebral edema-mediated secondary injury in patients with very large infarcts may further improve outcomes after reperfusion therapies.

Details

ISSN :
15244628 and 00392499
Database :
OpenAIRE
Journal :
Stroke, r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol, instname, Stroke, 52(11), 3450-3458. Lippincott Williams & Wilkins, Stroke, 3450-3458. Lippincott Williams and Wilkins, STARTPAGE=3450;ENDPAGE=3458;ISSN=0039-2499;TITLE=Stroke
Accession number :
edsair.doi.dedup.....c900106d6a56254514d57602b511820e