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Multicenter Study
. 2023 Feb;18(2):187-192.
doi: 10.1177/17474930221094693. Epub 2022 May 12.

Cerebrospinal fluid volume improves prediction of malignant edema after endovascular treatment of stroke

Frans Kauw  1   2 , Marie Louise E Bernsen  3 , Jan W Dankbaar  1 , Hugo Wam de Jong  1 , L Jaap Kappelle  2 , Birgitta K Velthuis  1 , H Bart van der Worp  2 , Aad van der Lugt  4 , Yvo Bwem Roos  5 , Lonneke Sf Yo  6 , Marianne Aa van Walderveen  7 , Jeannette Hofmeijer  8 , Edwin Bennink  1   9
Affiliations
Multicenter Study

Cerebrospinal fluid volume improves prediction of malignant edema after endovascular treatment of stroke

Frans Kauw et al. Int J Stroke. 2023 Feb.

Abstract

Background: The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a potential predictor of malignant edema formation in patients with acute ischemic stroke.

Aims: We aimed to evaluate the added value of the CSF/ICV ratio in a model to predict malignant edema formation in patients who underwent endovascular treatment.

Methods: We included patients from the MR CLEAN Registry, a prospective national multicenter registry of patients who were treated with endovascular treatment between 2014 and 2017 because of acute ischemic stroke caused by large vessel occlusion. The CSF/ICV ratio was automatically measured on baseline thin-slice noncontrast CT. The primary outcome was the occurrence of malignant edema based on clinical and imaging features. The basic model included the following predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, occlusion of the internal carotid artery, collateral score, time between symptom onset and groin puncture, and unsuccessful reperfusion. The extended model included the basic model and the CSF/ICV ratio. The performance of the basic and the extended model was compared with the likelihood ratio test.

Results: Malignant edema occurred in 40 (6%) of 683 patients. In the extended model, a lower CSF/ICV ratio was associated with the occurrence of malignant edema (odds ratio (OR) per percentage point, 1.2; 95% confidence interval (CI) 1.1-1.3, p < 0.001). Age lost predictive value for malignant edema in the extended model (OR 1.1; 95% CI 0.9-1.5, p = 0.372). The performance of the extended model was higher than that of the basic model (p < 0.001).

Conclusions: Adding the CSF/ICV ratio improves a multimodal prediction model for the occurrence of malignant edema after endovascular treatment.

Keywords: Ischemic stroke; cerebrospinal fluid; computed tomography; malignant edema; thrombectomy.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.V.D.L. received fees from Stryker paid to institution. Y.B.W.E.M.R. received fees from Stryker paid to institution. The remaining authors had no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Flowchart of patient selection. NCCT: noncontrast CT.
Figure 2.
Figure 2.
Receiver operating characteristic curves of the models with (dotted line) and without (solid line) the ratio of intracranial CSF volume to ICV. The area under the curve of the basic model (solid line) was 0.86 and the area under the curve of the extended model (dotted line) was 0.88 (p = 0.141). CSF: cerebrospinal fluid; ICV: intracranial volume.
See this image and copyright information in PMC

References

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