2021 Volume 43 Issue 2 Pages 117-123
Background and Purpose: We have experienced acute ischemic stroke patients who had poor outcome due to acute brain swelling after successful recanalization with mechanical thrombectomy. The aim of this study was to investigate outcome of acute brain swelling after successful recanalization with mechanical thrombectomy and related factors retrospectively. Methods: This study included 101 patients who obtained successful recanalization (thrombolysis in cerebral infarction 2b or 3) after mechanical thrombectomy for occlusions of the internal carotid artery or middle cerebral artery from 2013 to January 2019. We classified by the distance of midline shift on FLAIR image including the lens nucleus and thalamus within 24 hours after treatment into two groups; more than 5 mm (the S group, n=18), and less than 5 mm (the N group, n=83). We compared demographics, radiological characteristics, and outcomes between both groups. Results: Univariate analysis showed the S group had significantly higher National Institude of Health Stroke Scale (NIHSS) on admission (median 21 vs. 18) and lower diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) on admission (median 3.5 vs. 8). Parenchymal hematoma was equivalent in each group. MRS 0–2 at 3 months was not significantly different between the two groups. In the S group, 11 patients had decompression craniectomy, 5 of which had good outcome, and DWI-ASPECTS were significantly higher than poor outcome group (median 6 vs. 3). Logistic regression analysis showed low DWI-ASPECTS (OR 0.55, P<0.001) was the independent factor of acute brain swelling. Conclusions: Acute brain swelling after successful thrombectomy was significantly associated with high NIHSS and low DWI-ASPECTS before treatment. This study suggests that a good outcome can be obtained if extracranial decompression is performed in young patients with high DWI-ASPECTS.
