{
  "abstract": "Introduction Recently, several trials observed improved functional outcomes for endovascular thrombectomy (EVT) in patients presenting with large ischemic lesions. However, the effect of recanalization on lesion pathophysiology in large strokes is not yet well understood.Aim of Study We hypothesized that EVT is linked to edema reduction as major pathophysiological link, independent of lesion size.Method The TENSION trial was a randomized, multicenter clinical trial enrolling patients with anterior circulation stroke and ASPECTS scores 3–5. Edema formation was calculated using the difference (∆NWU) of quantitative net water uptake (NWU) based on relative hypoattenuation in baseline and follow-up CT. Lesion extent in baseline and follow-up was assessed using ASPECTS. Mediation analyses were performed with EVT as independent variable and ∆NWU as mediator variable.Abstract A245 Figure 1Results For this pilot study, 92 patients were included. The median NWU and ASPECTS in follow-up CT were 26.8% (IQR: 1.9–34.7) and 2 (IQR: 1–3), respectively. Patients undergoing EVT showed significantly lower edema formation from baseline to follow-up (5.9% versus 12.8%, p<0.001). In mediation analysis, 34% of the effect of EVT was mediated by edema reduction, while only 14% was mediated by changes on lesion extent.Conclusion EVT significantly modified edema formation from baseline to follow-up imaging independent of the lesion extent. Reduced ischemic water uptake into the ischemic lesion may represent an important link between improved functional outcome following EVT in large strokes.Conflict of Interest Yes Personal fees from Acandis, Research grant from DFG, Research grant from ASNR",
  "authors": [
    {
      "affiliations": [
        "MSH Medical School Hamburg, Helios Kliniken Schwerin, Hamburg, Germany",
        "University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "Gabriel Broocks"
    },
    {
      "affiliations": [
        "Universitätsklinikum Heidelberg; National Coordinating Center Germany, Heidelberg, Germany"
      ],
      "name": "Martin Bendszus"
    },
    {
      "affiliations": [
        "Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Götz Thomalla"
    },
    {
      "affiliations": [
        "Comenius University’s Jessenius, Faculty of Medicine and University Hospital; National Coordinating Center Slovakia, Martin, Slovakia"
      ],
      "name": "Kamil Zeleňák"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University of Marburg, Marburg, Germany, Marburg, Germany"
      ],
      "name": "Andre Kemmling"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Susanne Gellißen"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Lukas Meyer"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Helge Kniep"
    }
  ],
  "title": "A245 Edema reduction as a key mediator of mechanical thrombectomy benefit in large core stroke",
  "uid": "5fa327bb-dad3-59e5-a136-fe3ca3d045d2"
}