AUTHOR=Yi Ting-yu , Wu Yan-min , Lin Ding-lai , Lang Feng-long , Yang Yu-yan , Pan Zhi-nan , Zheng Xiu-fen , Hong Gan-ji , Wu Mei-hua , Lin Xiao-hui , Chen Rong-cheng , Zeng Lisan , Chen Wen-huo , Sui Yi 

TITLE=Association of baseline core volume and early midline shift in acute stroke patients with a large ischaemic core

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1077824

DOI=10.3389/fneur.2022.1077824

ISSN=1664-2295

ABSTRACT=Background
Midline shift (MLS) is troublesome problem that may occur in patients with a large infarct core (LIC) and may be related to the baseline infarct core volume. The purpose of this study was to explore the relationship between baseline infarct core volume and early MLS presence.
Materials and Methods
Patients with acute intracranial large artery occlusion and a pretreatment relative cerebral blood flow (rCBF) <30% volume ≥50 ml on CT perfusion (CTP) were included, clinical outcomes following endovascular treatment (EVT) were retrospectively analyzed. The primary endpoint was MLS within 48 hours (early MLS presence). The association between baseline ICV and early MLS presence was evaluated with multivariable regression.
Results
Ultimately, 95 patients were included, and 29.5% (28/95) of the patients had early MLS. The number of patients with a baseline rCBF <15% volume (median [interquartile range], 46 [32–60] versus 29 [19–40]; P<0.001) was significantly larger in the early severe MLS presence group. A baseline rCBF<15% volume showed significantly better predictive accuracy for early MLS presence than an rCBF<30% volume (area under the curve, 0.74 versus 0.64, P=0.0023). In addition, an rCBF<15% volume ≥40 ml (odds ratio, 4.34 [95% CI, 1.571–11.996]) was associated with early MLS presence after adjustment for sex, age, baseline National Institutes of Health Stroke Scale score, onset-to-recanalization time.
Conclusion
In patients with an acute LIC following EVT, a pretreatment infarct core volume greater than 40 ml based on an rCBF<15% showed good predictive value for early MLS occurrence.