Abstract Details

Title Quantitative Assessment of Reperfusion Impact on Cerebral Edema and Functional Outcomes in Large-vessel Occlusion Stroke Patients

Topic Neuro Trauma and Critical Care

Presentation(s) S23 - Neurocritical Care (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Objective This study aimed to explore the connection between reperfusion and cerebral edema in more detail, utilizing CSF volumetrics and tissue water concentration.

Background Studies show that successful reperfusion after large-vessel occlusion (LVO) stroke can lead to reduced mass effect and midline shift (MLS). However, MLS typically occurs late in the edema cascade and only develops in approximately half of patients treated with endovascular thrombectomy (EVT).

Design/Methods Using a deep-learning algorithm, we measured cerebrospinal fluid (CSF) volumes and their interhemispheric ratio on CT images at baseline, 24 hours, and 72 hours following a stroke. Automated segmentation of infarct regions on follow-up scans was used to measure net water uptake (NWU), the ratio of density within infarcted tissue relative to the mirrored contralateral region. The change in edema markers from baseline to 24 hours, as well as 72-hour NWU, were dichotomized at the median into significant edema growth and low/moderate edema growth. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score.

Results This study included 137 patients (mean age 69 ± 15, mean NIHSS 14) with LVO stroke who underwent EVT. There was a gradual decrease in the CSF ratio change at 24 and 72 hours with lower (worse) TICI scores (p=0.023 and p<0.001, respectively). After adjusting for age, admission NIHSS, and ASPECT score, successful reperfusion was associated with lower odds of significant edema by CSF ratio change at 24 hours (aOR 0.25, 95% CI 0.1-0.6, p=0.002) and NWU at 72 hours (aOR 0.26, 95% CI 0.1-0.7, p=0.01) when compared with unsuccessful reperfusion. Lower CSF ratio growth and NWU at 24 hours were significantly associated with lower global disability measured by the modified Rankin Scale at 90 days (p<0.001 and p=.008, respectively).

Conclusions Successful reperfusion is associated with reduced edema and better functional outcomes following thrombectomy.

Authors/Disclosures
Madelynne Olexa PRESENTER	Miss Olexa has nothing to disclose.
Yelyzaveta Begunova	Miss Begunova has nothing to disclose.
Rajat Dhar, MD (Washington University in St. Louis School of Medicine)	Dr. Dhar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Mid-America Transplant. Dr. Dhar has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for UCB Pharma. The institution of Dr. Dhar has received research support from NINDS.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.

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