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Research ArticleADULT BRAIN

Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

A.D. Horsch, J.W. Dankbaar, T.A. Stemerdink, E. Bennink, T. van Seeters, L.J. Kappelle, J. Hofmeijer, H.W. de Jong, Y. van der Graaf and B.K. Velthuis on behalf of the DUST investigators
American Journal of Neuroradiology May 2016, 37 (5) 831-837; DOI: https://doi.org/10.3174/ajnr.A4637
A.D. Horsch
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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J.W. Dankbaar
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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T.A. Stemerdink
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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E. Bennink
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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T. van Seeters
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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L.J. Kappelle
bNeurology (L.J.K.), Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands
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J. Hofmeijer
cDepartment of Neurology (J.H.), Rijnstate Hospital, Arnhem, the Netherlands
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H.W. de Jong
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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Y. van der Graaf
dJulius Center for Health Sciences and Primary Care (Y.v.d.G.), Utrecht, the Netherlands.
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B.K. Velthuis
aFrom the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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Abstract

BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatment strategies. This study aimed to identify variables associated with the development of prominent edema in patients with large MCA infarcts.

MATERIALS AND METHODS: From the Dutch Acute Stroke Study (DUST), 137 patients were selected with large MCA infarcts on follow-up NCCT (3 ± 2 days after stroke onset), defined as ASPECTS ≤4. Prominent edema was defined as a midline shift of ≥5 mm on follow-up. Admission patient and treatment characteristics were collected. Admission CT parameters used were ASPECTS on NCCT and CBV and MTT maps, and occlusion site, clot burden, and collaterals on CTA. Permeability on admission CTP, and day 3 recanalization and reperfusion statuses were obtained if available. Unadjusted and adjusted (age and NIHSS) odds ratios were calculated for all variables in relation to prominent edema.

RESULTS: Prominent edema developed in 51 patients (37%). Adjusted odds ratios for prominent edema were higher with lower ASPECTS on NCCT (adjusted odds ratio, 1.32; 95% CI, 1.13–1.55) and CBV (adjusted odds ratio, 1.26; 95% CI, 1.07–1.49), higher permeability (adjusted odds ratio, 2.35; 95% CI, 1.30–4.24), more proximal thrombus location (adjusted odds ratio, 3.40; 95% CI, 1.57–7.37), higher clot burden (adjusted odds ratio, 2.88; 95% CI, 1.11–7.45), and poor collaterals (adjusted odds ratio, 3.93; 95% CI, 1.78–8.69).

CONCLUSIONS: Extensive proximal occlusion, poor collaterals, and larger ischemic deficits with higher permeability play a role in the development of prominent edema in large MCA infarcts.

ABBREVIATIONS:

ACA
anterior cerebral artery
ECASS
European Cooperative Acute Stroke Study
  • © 2016 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 37 (5)
American Journal of Neuroradiology
Vol. 37, Issue 5
1 May 2016
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Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts
A.D. Horsch, J.W. Dankbaar, T.A. Stemerdink, E. Bennink, T. van Seeters, L.J. Kappelle, J. Hofmeijer, H.W. de Jong, Y. van der Graaf, B.K. Velthuis
American Journal of Neuroradiology May 2016, 37 (5) 831-837; DOI: 10.3174/ajnr.A4637

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Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts
A.D. Horsch, J.W. Dankbaar, T.A. Stemerdink, E. Bennink, T. van Seeters, L.J. Kappelle, J. Hofmeijer, H.W. de Jong, Y. van der Graaf, B.K. Velthuis
American Journal of Neuroradiology May 2016, 37 (5) 831-837; DOI: 10.3174/ajnr.A4637
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