Endovascular stroke treatment’s impact on malignant type of edema (ESTIMATE)

Background and purpose In patients with acute ischemic stroke and large vessel occlusion, the prognosis has improved tremendously since the implementation of endovascular thrombectomy (EVT). The effect of EVT on the incidence of malignant middle cerebral artery infarctions (MMI) has not been studied...

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Bibliographic Details
Published in:Journal of neurology 2019-01, Vol.266 (1), p.223-231
Main Authors: Fuhrer, Hannah, Schönenberger, Silvia, Niesen, Wolf-Dirk, Seide, Svenja, Meyne, Johannes, Gerner, Stefan T., Vollmuth, Christoph, Beck, Christopher, Meckel, Stephan, Schocke, Michael, Wodarg, Fritz, Huttner, Hagen B., Möhlenbruch, Markus A., Kieser, Meinhard, Ringleb, Peter, Neugebauer, Hermann
Format: Article
Language:English
Subjects:
Aged
Brain Edema - epidemiology
Brain Edema - prevention & control
Brain Ischemia - epidemiology
Brain Ischemia - surgery
Cardiovascular system
Cerebral blood flow
Edema
Endovascular Procedures
Female
Follow-Up Studies
Humans
Incidence
Ischemia
Male
Medical prognosis
Medicine
Medicine & Public Health
Mortality
Neurology
Neuroradiology
Neurosciences
Original Communication
Patients
Regression analysis
Retrospective Studies
Stroke
Stroke - epidemiology
Stroke - surgery
Thrombectomy
Treatment Outcome
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Summary:Background and purpose In patients with acute ischemic stroke and large vessel occlusion, the prognosis has improved tremendously since the implementation of endovascular thrombectomy (EVT). The effect of EVT on the incidence of malignant middle cerebral artery infarctions (MMI) has not been studied before. Methods ESTIMATE, a multicenter retrospective study, evaluates data of ischemic stroke patients with occlusion in the anterior circulation in the years of 2007–2015 comparing three treatment options (no therapy; IV-TPA; IV-TPA plus EVT or EVT only). Primary endpoint of the study was the incidence of MMI on follow-up imaging and mortality rates. Secondary endpoints were functional outcome, further clinical and imaging data. Logistic and Cox-regression models with a propensity score weighting approach were applied to evaluate differences between treatment groups. Results In 2161 patients over 9 years, EVT reduced the MMI rates significantly: patients without acute stroke treatment had increased odds for MMI of 1.57 [95% confidence interval (CI) 1.49–1.65]. In contrast, after treatment with IV-TPA, only we observed an OR of 0.88 (95% CI 0.83–0.94, p  
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-018-9127-x