ABSTRACT NUMBER: ESOC2026A1410 EARLY EDEMA PROGRESSION ON CT IS ASSOCIATED WITH INFARCT GROWTH AFTER ACUTE ISCHEMIC STROKE: A POST-HOC ANALYSIS OF THE CHABLIS-T TRIALS

Abstract Background and aims Net water uptake (NWU), a recently introduced CT-based method, was used as an imaging biomarker to evaluate the progression of ischemic edema. Whether early edema progression contributed to infarct growth despite recanalization remained unclear. Methods This was an exploratory post-hoc analysis of the CHABLIS- T (Chinese Acute Tissue- Based Imaging Selection for Lysis in Stroke-Tenecteplase) trials. Quantitative NWU is based on the densitometric assessment of hypoattenuation of the ischemic lesion to the physiological tissue density as validated in previous studies. CT perfusion was used to determine the region of interest (core and penumbra region). Early edema progression (ΔNWU) was defined as the difference in NWU measured in 24-hour follow-up CT and admission CT. Infarct growth volume was the difference of final infarct volume and baseline core volume. The association of ΔNWU and infarct growth was examined by linear regression. Results In 136 patients analyzed, ΔNWU was strongly correlated with infarct growth volume (core region, Pearson’s P=0.010; penumbra region, Pearson’s P=0.015). After adjusted for age, baseline NIHSS, baseline ASPECTS, reperfusion status and any hemorrhagic transformation, ΔNWU was significantly associated with increased infarct growth (core region, β=1.90, 95% CI: 0.84-2.96, P<0.001; penumbra region, β=1.28, 95% CI: 0.34-2.23, P=0.008). In patients without reperfusion, edema progression in the penumbra showed a marginal significance to decreased chance of functional independence at 90 days (ΔNWU, OR=0.94, 95% CI: 0.89-1.00, P=0.061). Conclusions This study demonstrated that early edema progression was independently associated with infarct growth despite recanalization, establishing it as a valuable imaging biomarker of ischemic injury progression. Conflict of interest Nothing to disclose.