{
  "abstract": "Background Malignant cerebral edema (MCE) following basilar artery occlusion (BAO) thrombectomy is a critical, yet understudied, complication.Objective To investigate the incidence, predictors, and clinical impact of MCE in patients with BAO after endovascular thrombectomy (EVT).Methods In this retrospective analysis of the national multicenter PERSIST Registry (2422 patients with BAO treated with EVT recruited from 65 Chinese centers, 2015–2022), MCE was defined as Jauss score ≥4 on follow-up imaging. Multivariable logistic regression identified predictors of MCE and its association with 90-day outcomes. A favorable outcome was defined as achieving a modified Rankin Scale score of 0–3 at 90 days.Results A total of 1883 patients who met the eligibility requirements were included. MCE occurred in 39.6% (746/1883) of patients. Independent predictors included admission systolic blood pressure ≥160 mm Hg (aOR=1.26, 95% CI 1.02 to 1.54), prolonged procedure time (aOR=1.01, 95% CI 1.01 to 1.01), BATMAN score ≥7 (aOR=0.68, 95% CI 0.55 to 0.84), and vertebral V4 occlusion (vs proximal BA: aOR=0.68, 95% CI 0.52 to 0.89). Successful reperfusion reduced MCE risk (aOR=0.57, 95% CI 0.42 to 0.75). Diabetes mellitus exhibited an inverse association (aOR=0.78, 95% CI 0.61 to 0.99). MCE predicted lower odds of favorable outcome (aOR=2.41, 95% CI 1.94 to 3.01; P<0.001) and higher mortality (aOR=1.85, 95% CI 1.51 to 2.27; P<0.001) at 90 days.Conclusions MCE complicates 39.6% of patients with BAO after EVT and portends catastrophic outcomes despite successful recanalization. Shortening the procedure time, increasing the likelihood of first-pass success, and optimal admission blood pressure management might be targets to decrease MCE for patients with BAO undergoing EVT.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China"
      ],
      "name": "Xiangjun Xu"
    },
    {
      "affiliations": [
        "Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Thanh N Nguyen"
    },
    {
      "affiliations": [
        "Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, Zhejiang, China"
      ],
      "name": "Zhongming Qiu"
    },
    {
      "affiliations": [
        "Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Yingjie Xu"
    },
    {
      "affiliations": [
        "NeuroMedical Center, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China"
      ],
      "name": "Zhixin Huang"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China"
      ],
      "name": "Wei Li"
    },
    {
      "affiliations": [
        "Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Wen Sun"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China"
      ],
      "name": "Yapeng Guo"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China"
      ],
      "name": "Junfeng Xu"
    },
    {
      "affiliations": [
        "Department of Neurology, Jingdezhen First People’s Hospital, Jingdezhen, Jiangxi, China"
      ],
      "name": "Shunfu Jiang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xingguo People's Hospital, Xinguo Hospital of Gannan Medical University, Ganzhou, Jiangxi, China"
      ],
      "name": "Hai Hu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xingguo People's Hospital, Xinguo Hospital of Gannan Medical University, Ganzhou, Jiangxi, China"
      ],
      "name": "Fang Xie"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xingguo People's Hospital, Xinguo Hospital of Gannan Medical University, Ganzhou, Jiangxi, China"
      ],
      "name": "Guangui Yang"
    },
    {
      "affiliations": [
        "Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, Zhejiang, China"
      ],
      "name": "Hongmei Xu"
    },
    {
      "affiliations": [
        "Department of Neurology, The First People’s Hospital of Yongkang Affiliated to Hangzhou Medical College, Yongkang, Zhejiang, China"
      ],
      "name": "Guoqiang Xu"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China"
      ],
      "name": "Xianjun Huang"
    }
  ],
  "title": "Incidence, predictors, and outcomes of malignant cerebral edema after acute basilar artery occlusion thrombectomy",
  "uid": "052b4c4a-ac8b-5aa5-833e-8c73a6b6b2da"
}