Association Between Hemodynamics After Endovascular Thrombectomy and Cerebral Edema Development
Yelyzaveta Begunova1, David Bartolome1, Madelynne Olexa1, Atul Kumar2, Yasheng Chen2, Teng Peng1, Santiago Ortega Gutierrez3, Kevin Sheth4, Rajat Dhar5, Nils Petersen6
1Yale University School of Medicine, 2Washington University School of Medicine, 3University of Iowa, 4Yale UniversityDivision of Neuro and Critical Care, 5Washington University in St. Louis School of Medicine, 6Yale University
Objective:
This study examined the relationship between systolic blood pressure (SBP) trajectories after endovascular thrombectomy (EVT) and the development of cerebral edema.
Background:
High blood pressure post-EVT can cause cerebral hyperemia and disrupt the blood-brain barrier. However, its role in cerebral edema development is incompletely understood.
Design/Methods:
Large-vessel occlusion stroke patients who underwent EVT were prospectively enrolled. Cerebrospinal fluid (CSF) volume was measured using a deep-learning algorithm on CT images at baseline, 24 hours, and 72 hours after stroke. The ratio of CSF volumes between hemispheres was calculated. 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. Latent variable mixture modeling (LVMM) divided patients into SBP trajectory groups during the first 72 hours post-EVT: low, moderate, moderate-to-high, high-to-moderate, and high. Measures of edema (change in CSF ratio, NWU) were compared between groups.
Results:
One hundred patients (mean age 70 ± 16, mean NIHSS 15) were analyzed. Edema was assessed by a gradual increase in NWU (20.5, 27.0) at 24 and 72 hours, respectively, and by a reduction in CSF ratio (0.95, 0.78, 0.68) in the affected hemisphere at baseline, 24 hours, and 72 hours, respectively. LVMM identified five distinct SBP trajectories. Higher SBP trajectories were associated with higher NWU but not lower CSF ratio at 24 hours (p<0.001 and p=0.343, respectively). After adjusting for age, admission NIHSS, and TICI score, the moderate-to-high and high-to-moderate SBP trajectory groups were independently associated with higher NWU (aOR 11.40, 95% CI 2.14-20.66) and (aOR 10.97, 95% CI 0.12-21.82), respectively, relative to the low and moderate SBP trajectory groups.
Conclusions:
Higher SBP trajectories are associated with an increase in NWU post-EVT. NWU is a promising radiographic biomarker for measuring cerebral edema during the early phase after stroke.