ArticleThe neurologist2026
Prediction of Malignant Brain Edema Based on Contrast Agent Exudation After Mechanical Thrombectomy for Anterior Circulation Occlusion.
Article in The neurologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveMalignant brain edema (MBE) after mechanical thrombectomy (MT) for anterior circulation occlusion leads to poor outcomes. Although contrast agent extravasation (CAE) indicates blood-brain barrier disruption, its predictive value for MBE remains uncertain. This study evaluated whether the CAE-Alberta Stroke Program Early CT Score (CAE-ASPECTS) derived from dual-source computed tomography (CT) could predict MBE after anterior circulation recanalization with MT.
methodsPatients with anterior circulation occlusion undergoing mechanical thrombectomy (MT) were divided into malignant brain edema (MBE) and non-MBE groups. The primary outcome was to determine whether postoperative CAE-ASPECTS scores predicted MBE. The secondary outcomes were to identify factors influencing malignant brain edema and to examine the association between CAE-ASPECTS and 90-day modified Rankin Scale (mRS) and 72-hour intracerebral hemorrhage.
resultsThe MBE group had a significantly lower median postoperative CAE-ASPECT score. After adjusting for confounding factors, CAE-ASPECTS remained independently associated with MBE. Lower CAE-ASPECTS, higher National Institutes of Health Stroke Scale (NIHSS) score, and longer operative time were associated with increased MBE risk. The regression model yielded a predictive accuracy of 93%. Favorable 90-day mRS (0 to 2) was more common in the non-MBE group, and mortality was lower. Finally, cerebral hemorrhagic transformation was inversely correlated with CAE-ASPECTS.
conclusionLower CAE-ASPECTS scores were significantly correlated with increased MBE incidence. Moreover, CAE-ASPECTS was an independent predictor of MBE, while cerebral hemorrhage transformation was negatively correlated with the CAE-ASPECTS after successful thrombectomy. Finally, CAE-ASPECTS, preoperative NIHSS, ASPECTS, and operative time collectively predict MBE with 93% sensitivity, providing a useful imaging biomarker for post-MT risk assessment.
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