Abstract TP062: Managing Cerebral Edema in Large Vessel Occlusion: Does the Method of Hypertonic Saline Administration Matter?

Background: Cerebral edema is a leading cause of mortality in patients with acute ischemic stroke, particularly those with large vessel occlusion (LVO). Hypertonic saline (HTS) has been shown to be more effective than mannitol for managing cerebral edema. However, there is no established consensus regarding the optimal method of HTS administration—whether continuous infusion or intermittent bolus—based on serum sodium levels. This study aimed to examine current HTS administration practices in a comprehensive stroke center. Methods: We conducted a retrospective review of patients with LVO ischemic stroke who underwent endovascular thrombectomy, admitted to our stroke center between January 1, 2024, and April 30, 2025. Patients who received HTS were categorized into three groups: infusion only, bolus only, and combined infusion and bolus. Univariate analysis was performed using ANOVA for continuous variables and Chi-square tests for categorical variables. Results: Among 240 thrombectomies performed during the defined period, 151 patients received HTS: infusion only (n=85), bolus only (n=21), and combined (n=45). Baseline characteristics—including admission NIHSS, site of occlusion, and hemisphere of infarction—were comparable across groups. Patients receiving infusion or combined therapy were more likely to achieve a serum sodium level ≥145 mmol/L; however, the time to reach that target and the duration of sodium maintenance ≥145 mmol/L did not differ significantly between the groups. The combined therapy group demonstrated a higher incidence of midline shift on imaging and a greater frequency of decompressive craniectomy compared to the other groups. Pairwise comparisons showed that the combined group had significantly lower modified Rankin Scale (mRS) scores compared to the infusion-only group (p = 0.05), but significantly higher discharge NIHSS scores (p = 0.002). Regarding in-hospital mortality, the infusion-only group had the highest observed frequency. Conclusion: Our findings suggest that the method of HTS administration may influence clinical outcomes, including time to achieve sodium target, and functional status at discharge. Further investigation is warranted to clarify the role of HTS dosing strategies in the management of cerebral edema in acute ischemic stroke.