前循环急性大血管闭塞性卒中成功再通后发生恶性脑水肿的相关预测因素及结局分析OACSTPCD

Objective To investigate the incidence,predictors,and clinical outcome of malignant brain edema(MBE)after successful recanalization for acute anterior circulation large vessel occlusion stroke(ALVOS).Methods We retrospectively collected the data of 130 patients with ALVOS who underwent successful recanalization with endovascular treatment at the Department of Neurology of The Affiliated Hospital of Southwest Medical University from October 2018 to November 2020.Univariable and multivariable logistic regression analyses were performed to explore the incidence rate and predictors of MBE after successful recanalization for ALVOS.The receiver operating characteristic(ROC)curve was created.The clinical outcome was evaluated using the modified Rankin Scale at 90 days.Results Among the included 130 patients(male,62.3%),26(20.0%)developed MBE.The multivariable logistic regression analysis showed that the National Institutes of Health Stroke Scale(NIHSS)score(OR=1.180,95%CI 1.077-1.293,P<0.001)and the number of clot retrieval attempts>3(OR=3.759,95%CI 1.195-11.825,P=0.024)were independent factors affecting the development of MBE after successful recanalization in ALVOS.MBE was an independent risk factor for a poor outcome(OR=5.296,95%CI 1.855-15.122,P=0.002)and mortality(OR=34.850,95%CI 8.330-145.802,P<0.001)at 90 days.According to the ROC curve analysis,the area under the curve for the NIHSS score predicting the occurrence of MBE after successful recanalization in ALVOS was 0.813(95%CI 0.719-0.908,P<0.05),with a specificity of 73.1%and a sensitivity of 75.0%.The area under the curve of the number of clot retrieval attempts>3 was 0.721(95%CI 0.605-0.838,P<0.05),with a specificity of 78.8%and a sensitivity of 65.4%.Conclusion MBE following successful recana-lization is not rare in patients with ALVOS,which is associated with a poor clinical outcome,and the NIHSS score and the number of clot retrieval attempts>3 are independent predictors of the development of MBE.