Cerebrospinal fluid volume improves prediction of malignant edema after endovascular treatment of stroke

Background: The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a potential predictor of malignant edema formation in patients with acute ischemic stroke. Aims: We aimed to evaluate the added value of the CSF/ICV ratio in a model to predict...

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Published in:International journal of stroke 2023-02, Vol.18 (2), p.187-192
Main Authors: Kauw, Frans, Bernsen, Marie Louise E, Dankbaar, Jan W, de Jong, Hugo WAM, Kappelle, L Jaap, Velthuis, Birgitta K, van der Worp, H Bart, van der Lugt, Aad, Roos, Yvo BWEM, Yo, Lonneke SF, van Walderveen, Marianne AA, Hofmeijer, Jeannette, Bennink, Edwin
Format: Article
Language:English
Subjects:
Brain Ischemia - complications
Edema - complications
Endovascular Procedures - adverse effects
Endovascular Procedures - methods
Humans
Ischemic Stroke - complications
Prospective Studies
Spinal Puncture - adverse effects
Stroke - etiology
Thrombectomy - methods
Treatment Outcome
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Summary:Background: The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a potential predictor of malignant edema formation in patients with acute ischemic stroke. Aims: We aimed to evaluate the added value of the CSF/ICV ratio in a model to predict malignant edema formation in patients who underwent endovascular treatment. Methods: We included patients from the MR CLEAN Registry, a prospective national multicenter registry of patients who were treated with endovascular treatment between 2014 and 2017 because of acute ischemic stroke caused by large vessel occlusion. The CSF/ICV ratio was automatically measured on baseline thin-slice noncontrast CT. The primary outcome was the occurrence of malignant edema based on clinical and imaging features. The basic model included the following predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, occlusion of the internal carotid artery, collateral score, time between symptom onset and groin puncture, and unsuccessful reperfusion. The extended model included the basic model and the CSF/ICV ratio. The performance of the basic and the extended model was compared with the likelihood ratio test. Results: Malignant edema occurred in 40 (6%) of 683 patients. In the extended model, a lower CSF/ICV ratio was associated with the occurrence of malignant edema (odds ratio (OR) per percentage point, 1.2; 95% confidence interval (CI) 1.1–1.3, p 
ISSN:1747-4930
1747-4949
DOI:10.1177/17474930221094693