Abstract 321: Net Water Uptake as a Marker Linking Endovascular Therapy Results to Brain Edema Development in Ischemic Stroke
Notice bibliographique
Résumé
Introduction/Purpose Several randomized clinical trials have demonstrated the benefit of endovascular treatment (EVT) over intravenous thrombolysis for large vessel occlusion (LVO) in acute ischemic stroke (AIS). However, postoperative brain edema and consequent hemorrhagic transformation remain the most dangerous EVT complications, which might lead to brain herniation due to malignant brain swelling. A new densitometric parameter (net water uptake ‐ NWU) can measure brain edema on computed tomography (CT). Because favorable and unfavorable EVT outcome subgroups are underrepresented in previous thrombectomy studies, we hypothesized that edema progression would depend on recanalization status. The aim was to study changes in brain tissue hydration using quantitative NWU in comparison to EVT results at LVO. Materials/Methods This retrospective, non‐randomized, observational, single‐center study included 137 patients (women 67; men 70, age 63 years [59;67]) with acute ischemic stroke (AIS) resulting from large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT). The protocol was reviewed and approved by the Institutional Ethical Committee. Inclusion criteria: (1) AIS due to LVO of the M1 segment of the middle cerebral artery or distal internal carotid artery; (2) hospital admission within 12 hours after known onset; (3) computed tomography (CT) performed with Alberta Stroke Program Early CT Score (ASPECTS) of ≥5 without signs of intracerebral hemorrhage; (4) availability of follow‐up CT within 24 hours after symptom onset without signs of intracerebral hemorrhage. Ischemic zones were established using multiphase perfusion CT (PCT) at admission on a 160‐slice scanner (Canon Aquilion Prime, Japan), with thresholds of cerebral blood volume <2.0 ml/100 g and mean transit time >145% compared with the contralateral hemisphere. Net water uptake (NWU) in ischemic zones was calculated using non‐contrast CT at admission and follow‐up after EVT using the following equation NWU = (1 ‐ D ischemia / D normal ) × 100%, where D ischemia is the ischemic “penumbra” density (Hounsfield unit) and D normal is the density of normal brain tissue in the symmetrical zone of the contralateral hemisphere. EVT was performed under general anesthesia or conscious sedation using approved devices, including stent retrievers and aspiration catheters. Data are shown as median [interquartile range]. Analysis of variance (ANOVA) models were performed. Pearson's correlation coefficients were used to assess agreement between computed variables. Regression lines and confidence limits are for illustrative purposes only. P<0.05 was considered statistically significant. Results NWU at admission was significantly lower in the successful EVT group (median 3.4%) than in the unsuccessful group (5.1%; p<0.05). Follow‐up NWU rose in both cohorts but remained lower after successful reperfusion (7.2% vs. 12.8%; p<0.001). The relative NWU increase was ∼2‐fold with successful EVT and ∼3‐fold when reperfusion failed. 53 patients had successful vessel recanalization (Thrombolysis in Cerebral Infarction 2b‐3), while 84 had persistent or recurrent LVO (TICI 0‐2a). Conclusion Successful EVT correlates with reduced brain edema development as measured by NWU, highlighting the importance of recanalization status in mitigating ischemic injury and potential complications like hemorrhagic transformation. These findings underscore NWU as a valuable tool for predicting edema progression and guiding post‐EVT management in AIS patients with LVO.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».