Malignant Cerebral Edema after Large-Core Anterior Circulation Stroke in the Thrombectomy Era: Prediction and Neurocritical Care Pathways

Walcott BP, Miller JC, Kwon CS, et al. Outcomes in severe middle cerebral artery ischemic stroke. Neurocrit Care. 2014;21(1):49–53.

Article  Google Scholar 

Torbey MT, Bösel J, Rhoney DH, et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-Intensive Care and Emergency Medicine. Neurocrit Care. 2015;22(1):146–64.

Article  PubMed  Google Scholar 

Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med. 2022;386(14):1303–13.

Article  PubMed  Google Scholar 

Huo X, Ma G, Tong X, et al. Trial of endovascular therapy for acute ischemic stroke with large infarct. N Engl J Med. 2023;388(14):1272–83.

Article  PubMed  CAS  Google Scholar 

Sarraj A, Hassan AE, Abraham MG, et al. Trial of endovascular thrombectomy for large ischemic strokes. N Engl J Med. 2023;388(14):1259–71.

Article  PubMed  Google Scholar 

Bendszus M, Fiehler J, Subtil F, et al. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. The Lancet. 2023;402(10414):1753–63.

Article  Google Scholar 

Ong CJ, Chatzidakis S, Ong JJ, et al. Updates in management of large hemispheric infarct. Semin Neurol. 2024;44(2):111–23.

Google Scholar 

Sarraj A, Savitz S, Pujara D, et al. Endovascular thrombectomy for large ischemic stroke across ischemic injury spectrum: an observational study. Stroke. 2023;54(10):2542–51.

Google Scholar 

Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocrit Care. 2020;32(3):647–66.

Article  PubMed  PubMed Central  Google Scholar 

Li J, Chen Y, Zhang X, et al. External validation and modification of the EDEMA score for predicting malignant brain edema after acute ischemic stroke. Neurocrit Care. 2020;32(1):104–12.

Article  Google Scholar 

Huang X, Chen C, Zhang J, et al. Predicting the emergence of malignant brain oedema in acute ischaemic stroke: a prospective multicentre study with development and validation of predictive modelling. EClinicalMedicine. 2023;59:101970.

Google Scholar 

Zhao Z, Zhang J, Jiang X, et al. Is the malignant brain edema score a reliable tool for predicting malignant progression of middle cerebral artery infarctions? Front Neurol. 2020;11:596.

Google Scholar 

Broocks G, Flottmann F, Scheibel S, et al. Quantitative lesion water uptake in acute stroke computed tomography is a predictor of malignant infarction. Stroke. 2018;49(8):1906–12.

Article  PubMed  Google Scholar 

Yuan K, Wang X, Chen C, et al. Development and validation of an interpretable machine learning model to predict malignant cerebral edema after acute ischemic stroke. Front Neurol. 2024;15:1694030.

Google Scholar 

Baethge C, Goldbeck-Wood S, Mertens S. SANRA—A scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. https://doi.org/10.1186/s41073-019-0064-8.

Article  PubMed  PubMed Central  Google Scholar 

Cannarsa GJ, Simard JM. Decompressive craniectomy for stroke: who, when, and how. Neurol Clin. 2022;40(2):321–36.

Article  PubMed  Google Scholar 

Yang Q, Huang Q, Hu Z, et al. Decompressive hemicraniectomy versus medical treatment of malignant middle cerebral artery infarction: a systematic review and meta-analysis. Biosci Rep. 2020;40(1):BSR20191448.

Article  Google Scholar 

Albers GW, Heit JJ, Lansberg MG, et al. Exploring the limits of endovascular therapy for large core patients: where do we need more data? Stroke. 2024;55(3):603–11.

Google Scholar 

Chen H, Lee JS, Michel P, et al. Endovascular stroke thrombectomy for patients with large ischemic core: a review. JAMA Neurol. 2024;81(4):415–24.

Google Scholar 

Matsukawa H, Kiura Y, Sakai N, Yamagami H, Uchida K, Morimoto T, et al. Effect of endovascular therapy on subsequent decompressive hemicraniectomy in cardioembolic ischemic stroke with proximal intracranial occlusion in the anterior circulation: sub-analysis of the RESCUE-Japan Registry 2. Cerebrovasc Dis. 2019;48(1–2):9–16. https://doi.org/10.1159/000502313.

Article  PubMed  Google Scholar 

Thomalla G, Fiehler J, Subtil F, et al. Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial. Lancet Neurol. 2024. https://doi.org/10.1016/S1474-4422(24)00278-3.

Article  PubMed  Google Scholar 

Lim GZ, Lai JY, Seet CYH, et al. Revolutionizing the management of large-core ischaemic strokes: decoding the success of endovascular therapy in the recent stroke trials. J Neurol Neurosurg Psychiatry. 2023;94(10):854–61.

Google Scholar 

Gerzanich V, Woo SK, Vennekens R, et al. De novo expression of TRPM4 initiates secondary hemorrhage in spinal cord injury. Nat Med. 2009;15(2):185–91.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Simard JM, Chen M, Tarasov KV, et al. Newly expressed SUR1-regulated NC(Ca-ATP) channel mediates cerebral edema after ischemic stroke. Nat Med. 2006;12(4):433–40.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Gu YH, Zhou C, Piao Z, et al. Cerebral edema after ischemic stroke: pathophysiology and underlying mechanisms. Front Neurosci. 2022;16:988283.

Article  PubMed  PubMed Central  Google Scholar 

Eisenberg HM, Frankowski RF, Contant CF, et al. BIIB093 (IV glibenclamide): an investigational compound for the prevention and treatment of severe cerebral edema. Expert Opin Investig Drugs. 2019;28(12):1031–40.

Article  Google Scholar 

Sheth KN, Elm JJ, Molyneaux BJ, et al. Safety and efficacy of intravenous glyburide on brain swelling after large hemispheric infarction (GAMES-RP): a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2016;15(11):1160–9.

Article  PubMed  CAS  Google Scholar 

Mohammed HE, Elshafei M, Abdelaziz M, et al. The efficacy and safety of glibenclamide in improving cerebral edema and neurological outcomes in stroke: a GRADE-evaluated systematic review and meta-analysis with subgroup analysis. Neurocrit Care. 2025;43(3):1013–32.

Article  PubMed  PubMed Central  Google Scholar 

Sheth KN, Petersen NH, Cheung K, et al. Long-term outcomes in patients aged ≤70 years with intravenous glyburide from the phase II GAMES-RP study of large hemispheric infarction: an exploratory analysis. Stroke. 2018;49(6):1457–63.

Article  PubMed  PubMed Central  Google Scholar 

Wu S, Yuan R, Wang Y, et al. Predictors of malignant cerebral edema in cerebral artery infarction: a meta-analysis. J Neurol Sci. 2020;409:116607.

Article  Google Scholar 

Kimberly WT. Predicting malignant cerebral edema after large hemispheric stroke. Neurocrit Care. 2020;32:84–5. https://doi.org/10.1007/s12028-019-00841-1.

Article  PubMed  PubMed Central  Google Scholar 

Dhar R, Yuan K, Kulik T, et al. Quantitative serial CT imaging-derived features improve prediction of malignant cerebral edema after ischemic stroke. Neurocrit Care. 2020;33(3):785–92.

Article  PubMed  PubMed Central  Google Scholar 

Chen Z, Zhang R, Xu F, et al. Automated estimation of quantitative lesion water uptake as a prognostic biomarker in large-vessel occlusion stroke patients. Am J Neuroradiol. 2023;44(1):33–9.

Article  Google Scholar 

Jo HW, Park BS, Kim JH, et al. A simple prediction score system for malignant brain edema progression in large hemispheric infarction. PLoS ONE. 2017;12(2):e0171425.

Article  PubMed  PubMed Central  Google Scholar 

Fu G, Qi Z, Lian S, et al. Image patch-based net water uptake and radiomics models predict malignant cerebral edema after ischemic stroke. Front Neurol. 2020;11:609747.

Article  PubMed  PubMed Central  Google Scholar 

DeHoff G, Lau W. Medical management of cerebral edema in large hemispheric infarcts. Front Neurol. 2022;13:1037584.

Article  Google Scholar 

Yang P, Song L, Zhang Y, ENCHANTED2/MT Investigators, et al. Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial. Lancet. 2022;400(10363):1585–96. https://doi.org/10.1016/S0140-6736(22)01882-7.

Article  PubMed  Google Scholar 

Mistry EA, Hart KW, Davis LT, et al. Blood pressure management after endovascular therapy for acute ischemic stroke: the BEST-II randomized clinical trial. JAMA. 2023;330(9):821–31.

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