Background and Purpose- A large infarct and expanding cerebral edema (CED) due to a middle cerebral artery occlusion confers a 70% mortality unless treated surgically. Reperfusion may cause blood-brain barrier disruption and a risk for cerebral edema and secondary parenchymal hemorrhage (PH). We aimed to investigate the effect of recanalization on development of early CED and PH after recanalization therapy. Methods- From the SITS-International Stroke Treatment Registry, we selected patients with signs of artery occlusion at baseline (either Hyperdense Artery Sign or computed tomography/magnetic resonance imaging angiographic occlusion). We defined recanalization as the disappearance of radiological signs of occlusion at 22 to 36 hours. Primary outcome was moderate to severe CED and secondary outcome was PH on 22- to 36-hour imaging scans. We used logistic regression with adjustment for baseline variables and PH. Results- Twenty two thousand one hundred eighty-four patients fulfilled the inclusion criteria (n=18 318 received intravenous thrombolysis, n=3071 received intravenous thrombolysis+thrombectomy, n=795 received thrombectomy). Recanalization occurred in 64.1%. Median age was 71 versus 71 years and National Institutes of Health Stroke Scale score 15 versus 16 in the recanalized versus nonrecanalized patients respectively. Recanalized patients had a lower risk for CED (13.0% versus 23.6%), adjusted odds ratio (aOR), 0.52 (95% CI, 0.46-0.59), and a higher risk for PH (8.9% versus 6.5%), adjusted odds ratio, 1.37 (95% CI, 1.22-1.55), than nonrecanalized patients. Conclusions- In patients with acute ischemic stroke, recanalization was associated with a lower risk for early CED even after adjustment for higher rate for PH in recanalized patients.

中文翻译：

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再通对溶栓和/或血管内治疗对缺血性卒中脑水肿的影响。

背景与目的-除非通过外科手术治疗，否则由于大脑中动脉闭塞引起的大面积梗塞和扩大性脑水肿（CED）可导致70％的死亡率。再灌注可能导致血脑屏障破坏，并有脑水肿和继发实质性出血（PH）的风险。我们旨在研究再通治疗对再通治疗后早期CED和PH的发展的影响。方法-从SITS-国际中风治疗登记处，我们选择了基线时有动脉阻塞征象的患者（高密度动脉征或计算机断层扫描/磁共振成像血管造影术的阻塞）。我们将再通定义为在22到36小时内放射学迹象消失。主要结局为中度至重度CED，次要结局为22到36小时影像学检查的PH。我们使用逻辑回归对基线变量和PH进行了调整。结果-21.84例患者符合纳入标准（n = 18 318接受了静脉溶栓治疗，n = 3071接受了静脉溶栓+血栓切除术，n = 795接受了血栓切除术）。再通发生率为64.1％。再通和未再通的患者的中位年龄分别为71岁和71岁，美国国立卫生研究院卒中量表的得分分别为15分和16分。再次手术的患者发生CED的风险较低（13.0％对23.6％），调整后的优势比（aOR）为0.52（95％CI，0.46-0.59），发生PH的风险较高（8.9％对6.5％），调整后的优势比未再手术的患者的比率为1.37（95％CI，1.22-1.55）。结论-在急性缺血性中风患者中，