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Original research
Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke
  1. Xianjun Huang,
  2. Qian Yang,
  3. Xiaolei Shi,
  4. Xiangjun Xu,
  5. Liang Ge,
  6. Xianhui Ding,
  7. Zhiming Zhou
  1. Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
  1. Correspondence to Dr. Zhiming Zhou, Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China ; neuro_depar{at}


Background Malignant brain edema (MBE) is a devastating complication in ischemic stroke. Data on MBE in patients who have had mechanical thrombectomy (MT) are relatively scarce.

Objective To investigate the incidence, predictors, and clinical outcomes of MBE in patients after MT.

Methods We included 130 consecutive patients after MT caused by anterior circulation large vessel occlusion stroke, treated with MT. MBE was defined as a midline shift of ≥5 mm on the follow-up imaging within 72 hours after MT. Characteristics of patients at admission and details of treatment were collected. The 90-day modified Rankin scale score was used as a measure of functional outcomes.

Results Of the 130 patients (age, 68.6±10.9 years; male, 50%), 35 (26.9%) patients developed MBE. The patients with MBE had a lower rate of functional independence (OR=7.831; 95% CI 1.731 to 35.427; p=0.008) and significantly higher mortality at 90 days (OR=7.958; 95% CI 2.274 to 27.848; p=0.001) than patients without MBE. In 104 (80%) patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score of 2b–3), 24 (23.1%) patients exhibited MBE. After adjustment for confounding, ICA occlusion (OR=3.746; 95% CI 1.169 to 12.006; p=0.026) and worse collateral score (grade 1 vs grade 0: OR=0.727; 95% CI 0.192 to 2.753; p=0.638; grade 2 vs grade 0: OR=0.130; 95% CI 0.021 to 0.819; p=0.030) were significantly associated with the development of MBE, despite successful recanalization.

Conclusions MBE after MT is not uncommon and was related to poor functional outcomes. Localization of a vessel occlusion and collateral status may play a role in the development of MBE.

  • stroke
  • thrombectomy
  • complication

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  • XH and QY contributed equally.

  • Contributors XH, QY, and ZZ: study design. XS and XX: data acquisition. LG and XD: image analysis. XH and QY: primary manuscript writing. ZZ: critical revision and final approval of the manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China grant number 81701061.

  • Competing interests None declared.

  • Ethics approval The study was approved by the local ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.