Objectives

Space-occupying cerebral edema is the main cause of mortality and poor functional outcome in patients with large cerebral artery occlusion (LVO). We aimed to determine whether recanalization of LVO would augment cerebral edema volume and the impact on functional outcome and quality of life (QoL).

Materials and Methods

Prospectively, 43 patients with large middle cerebral artery territory infarction or NIHSS ≥ 12 on admission were enrolled. The degree of recanalization (partial and complete versus no recanalization) was assessed by computed tomography (CT)-angiography or Duplex ultrasound more than 24 h after symptom onset. Cerebral edema volume was measured on follow up CTs by computer-based planimetry. Mortality, functional outcome (by modified Ranking Scale (mRS) and Barthel Index (BI)) were assessed at discharge and 12 months, and QoL (by SF-36 and EQ-5D-3L) at 12 months.

Results

Mean cerebral edema volume was 333±141 ml without recanalization (n=13, group 1) and 276±140 ml with partial or complete recanalization (n=30, group 2, p= 0.23). There were no significant differences in mortality at discharge (38% versus 23%), at 12 months (58% versus 48%), in functional outcome at discharge (mRS 0–3: 0% both; mRS 4–5: 62% versus 77%) and at 12 months (mRS 0–3: 0% versus 11%; mRS 4–5: 42% versus 41%). The BI improved significantly from discharge to 12 months only in group 2 (p=0.001). Mean physical component score in SF-36 was 25.6±6.4, psychological component score was 41.9±14.1. In the EQ-5D-3L, most patients reported problems with activities of daily living, reduced mobility, and selfcare.

Conclusions

Recanalization of a large cerebral artery occlusion in the anterior circulation territories is not associated with amplification of post-ischemic cerebral edema but may be correlated with better long-term functional outcome. QoL was low and mainly dependent on physical disability. The association between recanalization, collateral status and development of cerebral edema after LVO and the effect on functional outcome and quality of life should be explored in a larger patient population.

中文翻译：

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再通对大半球性脑梗死患者脑水肿，长期结局和生活质量的影响

目标

占位性脑水肿是脑大动脉闭塞（LVO）患者死亡和功能预后不良的主要原因。我们旨在确定LVO的再通气是否会增加脑水肿的数量以及对功能结局和生活质量（QoL）的影响。

材料和方法

入选了43例大脑中动脉大面积梗死或NIHSS≥12的患者。症状发作后超过24小时，通过计算机断层扫描（CT）-血管造影或双重超声检查重新通气的程度（部分和完全通气与不重新通气）。通过基于计算机的平面测量法在后续CT上测量脑水肿量。在出院时和12个月时评估死亡率，功能结局（通过改良的等级量表（mRS）和Barthel指数（BI）），并在12个月时评估QoL（通过SF-36和EQ-5D-3L）。

结果

不进行再通的平均脑水肿体积为333±141 ml（n = 13，第1组），经部分或完全再通的平均脑水肿体积为276±140 ml（n = 30，第2组，p = 0.23）。出院时的功能结局在出院时的死亡率方面（38％对23％），出院时的死亡率（38％对48％）没有显着差异（mRS 0–3：均为0％； mRS 4–5：62％）对比77％）和12个月时（mRS 0–3：0％对11％； mRS 4–5：42％对41％）。仅在第2组中，BI从出院到12个月显着改善（p = 0.001）。SF-36的平均身体成分得分为25.6±6.4，心理成分得分为41.9±14.1。在EQ-5D-3L中，大多数患者报告了日常生活活动，行动不便和自我保健方面的问题。

结论

前循环区大脑动脉闭塞的再通与缺血后脑水肿的扩大无关，但可能与更好的长期功能预后相关。生活质量较低，主要取决于身体残疾。LVO后再通气，侧支状态和脑水肿的发展与对功能结局和生活质量的影响之间的联系应在更多的患者人群中进行探讨。