Association Between Hemodynamics After Endovascular Thrombectomy and Cerebral Edema Development (S4.008) (2023)

<h3>Objective:</h3> This study examined the relationship between systolic blood pressure (SBP) trajectories after endovascular thrombectomy (EVT) and the development of cerebral edema. <h3>Background:</h3> 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. <h3>Design/Methods:</h3> 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. <h3>Results:</h3> 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&lt;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. <h3>Conclusions:</h3> 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. <b>Disclosure:</b> Miss Begunova has nothing to disclose. Mr. Bartolome has nothing to disclose. Miss Olexa has nothing to disclose. Dr. KUMAR has nothing to disclose. Yasheng Chen has nothing to disclose. Dr. Peng has nothing to disclose. 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 $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for SVIN. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Siemens. The institution of Dr. Ortega Gutierrez has received research support from IschemiaView. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. 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. 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. Dr. Petersen has received research support from NIH.