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

Frans Kauw*, Marie Louise E. Bernsen, Jan W. Dankbaar, Hugo W.A.M. de Jong, L. Jaap Kappelle, Birgitta K. Velthuis, H. Bart van der Worp, Aad van der Lugt, Yvo B.W.E.M. Roos, Lonneke S.F. Yo, Marianne A.A. van Walderveen, Jeannette Hofmeijer, Edwin Bennink

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
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Abstract

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 < 0.001). Age lost predictive value for malignant edema in the extended model (OR 1.1; 95% CI 0.9–1.5, p = 0.372). The performance of the extended model was higher than that of the basic model (p < 0.001). Conclusions: Adding the CSF/ICV ratio improves a multimodal prediction model for the occurrence of malignant edema after endovascular treatment.

Original languageEnglish
Pages (from-to)187-192
Number of pages6
JournalInternational Journal of Stroke
Volume18
Issue number2
Early online date4 Apr 2023
DOIs
Publication statusPublished - 2023

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center and Amsterdam UMC. This research has been made possible by the Dutch Heart Foundation and The Netherlands Organization for Scientific Research (NWO), domain Applied and Engineering Sciences (TTW), as part of their joint strategic research program: “Earlier recognition of cardiovascular diseases” (grant number 14732).

Publisher Copyright:
© 2022 World Stroke Organization.

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