Malignant cerebral edema of endovascular treatment 6 to 24 hours after large vessel occlusion ischemic stroke: a multicenter retrospective cohort study

Accumulating evidence has demonstrated the feasibility and efficacy of endovascular treatment (EVT) in the late window (6–24 h). However, whether late-window EVT is associated with a higher risk of malignant cerebral edema (MCE) remains uncertain. Our aim is to assess whether late-window EVT is associated with MCE compared with early-window EVT (< 6 h). This multicenter, retrospective, cohort study analyzed data from four stroke centers. Patients receiving late-window EVT were matched 1:3 by age, sex, vascular risk factors, stroke etiology and previous drug use to early-window EVT. MCE was defined as a midline shift ≥ 5 mm on follow-up head CT within 72 h after EVT. Univariate and multivariate logistic regression was used to assess the association between time window and MCE. Among 480 patients (120 late-window, 360 early-window), the incidence of MCE was 24.2% in the late-window group and 21.4% in the controls ( P = 0.611). Onset-to-puncture time didn’t differ significantly between patients with and without MCE, poor outcome, mortality, END, or FR (all P > 0.05). Late-window EVT was not independently associated with MCE (OR = 1.028, P = 0.526), even after adjustment (OR = 1.072, P = 0.114). Findings were consistent across subgroups stratified by age, cardioembolism, NIHSS, and ASPECTS (all P > 0.05). Late-window EVT was not associated with a higher incidence of MCE or other adverse outcomes compared with early-window EVT. Concerns about MCE should not preclude acute ischemic stroke patients from receiving late-window EVT, providing evidence to support patient selection for EVT.