Title:Malignant Middle Cerebral Artery Infarction during Early versus Late
Endovascular Treatment in Acute Ischemic Stroke
Volume: 20
Issue: 2
Author(s): Wenting Guo, Ning Li, Jiali Xu, Jin Ma, Sijie Li, Changhong Ren, Jian Chen, Jiangang Duan, Qingfeng Ma, Haiqing Song, Wenbo Zhao*Xunming Ji*
Affiliation:
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
Keywords:
Stroke, endovascular therapy, time window, malignant middle cerebral artery infarction, radiological, thrombectomy era.
Abstract:
Introduction: Endovascular treatment (EVT) performed in the early time window has
been shown to decrease the incidence of malignant middle cerebral artery infarction (MMI). However,
the incidence of MMI in patients undergoing EVT during the late time window is unclear.
This study aimed to investigate the prevalence of MMI in patients undergoing late EVT and compare
it with that in patients undergoing early EVT.
Methods: We retrospectively analyzed consecutive patients with anterior large vessel occlusion
stroke who underwent EVT at Xuanwu Hospital between January 2013 and June 2021. Eligible
patients were divided into early EVT (within 6 h) and late EVT (6-24 h) groups according to the
time from their stroke onset to puncture and compared. The occurrence of MMI post-EVT was the
primary outcome.
Results: A total of 605 patients were recruited, of whom 300 (50.4%) underwent EVT within 6 h
and 305 (49.6%) underwent EVT within 6-24 h. A total of 119 patients (19.7%) developed MMI.
68 patients (22.7%) in the early EVT group and 51 patients (16.7 %) in the late EVT group developed
MMI (p = 0.066). After adjusting for covariate variables, late EVT was independently associated
with a lower incidence of MMI (odds ratio, 0.404; 95% confidence interval, 0.242-0.675; p =
0.001).
Conclusion: MMI is not an uncommon phenomenon in the modern thrombectomy era. Compared
with the early time window, patients selected by stricter radiological criteria to undergo EVT in the
late time window are independently associated with a lower incidence of MMI.
