Successful therapeutic reperfusion with endovascular treatment is associated with reduced edema and midline shift (MLS) in patients with acute ischemic stroke, according to a study published in JAMA Neurology.
This post hoc analysis examined the results of the MR CLEAN trial, a randomized, prospective, multicenter clinical trial that took place in The Netherlands between December 2010 and June 2014. This trial (Netherlands Trial Registry number: NTR1804; Current Controlled Trials number: ISRCTN10888758) included 462 patients presenting with acute anterior circulation ischemic stroke, comparing endovascular treatment with conventional methods of care.
Patients had a mean age of 65 years and were 41.8% female. A lower occurrence of midline shift was linked to successful recanalization (adjusted common odds ratio [acOR] .34; 95% CI, .21-.55; P <.001) and reperfusion (acOR .25; 95% CI, .12-.53; P <.001) treatments.
Midline shift led to poorer modified Rankin scale scores in patients who had not undergone recanalization or reperfusion treatments, resulting in respective logistic regression coefficient changes of 12.6% and 30.3%.
However, midline shift helped moderate the worse modified Rankin scale scores of patients displaying delayed reperfusion (regression coefficient [RC], 33.3%) or a lower Alberta Stroke Program Early Computed Tomography Score (RC, 64.2%).
Researchers conclude that “[successful] reperfusion was associated with reduced MLS. This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction.”
Kimberly WT, Dutra BG, Boers AM, et al; for the MR CLEAN Investigators. Association of reperfusion with brain edema in patients with acute ischemic stroke: a secondary analysis of the MR CLEAN trial [published online April 1, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2017.5162