ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1693606
Relationship between postinterventional cerebral hyperdensities and malignant brain edema in patients with acute ischemic stroke after mechanical thrombectomy
Provisionally accepted
- 1Second Affiliated Hospital of Soochow University, Suzhou, China
- 2Jinan City People's Hospita, Jinan, China
- 3University of South China Affiliated Nanhua Hospital, Hengyang, China
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Background: This study aimed to evaluate the predictive value of postinterventional cerebral hyperdensities (PCHDs) for malignant brain edema (MBE) in acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT). We sought to establish and validate a nomogram for predicting MBE in this population. Methods: This study included patients with acute anterior circulation large vessel occlusion stroke treated with MT at our hospital from May 2017 to July 2024. PCHDs were classified based on their distribution characteristics and extent. Multivariate logistic regression analysis was used to assess the predictive value of PCHDs subtypes for MBE. Receiver operating characteristic curve analysis identified optimal predictive thresholds. Least absolute shrinkage and selection operator regression was applied to select significant predictors of MBE to construct a nomogram. The nomogram's performance was evaluated using the C-index, calibration plots, and decision curve analysis. Results: Among 516 enrolled patients, 126 (24.4%) developed MBE. The cortex sign (adjusted odd ratio [OR]=6.290, 95% confidence interval [CI]: 2.581-15.329), basal ganglia sign (adjusted OR=4.081, 95%CI: 1.831-9.096), and combined sign (adjusted OR=8.295, 95%CI: 3.942-17.454) were independent risk factors for MBE. Higher PCHDs scores were inversely associated with MBE risk (adjusted OR=0.620, 95%CI: 0.534-0.719). The nomogram incorporating age, atrial fibrillation, baseline NIHSS score, occlusion site, white blood cell count, total cholesterol level, and PCHDs score demonstrated good discrimination (C-index: 0.904) and calibration (Hosmer-Lemeshow test, P=0.851) to predict MBE. Conclusion: PCHDs show a strong association with MBE in AIS patients. Our nomogram provides individualized prediction of post-MT MBE risk, though multicenter validation is required.
Keywords: Acute ischemic stroke, Mechanical thrombectomy, postinterventional cerebral hyperdensities, Malignant brain edema, nomogram
Received: 27 Aug 2025; Accepted: 11 Sep 2025.
Copyright: © 2025 Wang, Du, Zhao, Guo, Hou, Wang, Zhou and Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guodong Xiao, yarrowshaw@hotmail.com
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