TY  - JOUR
JF  - JAMA Neurology
A1  - Kimberly, WT
A1  - Dutra, BG
A1  - Boers, AMM
A1  - Alves, HCBR
A1  - Berkhemer, OA
A1  - Van Den Berg, L
A1  - Sheth, KN
A1  - Roos, YBWEM
A1  - Van Der Lugt, A
A1  - Beenen, LFM
A1  - Dippel, DWJ
A1  - Van Zwam, WH
A1  - Van Oostenbrugge, RJ
A1  - Lingsma, HF
A1  - Marquering, H
A1  - Majoie, CBLM
A1  - Koudstaal, PJ
A1  - Van Den Berg, LA
A1  - Nederkoorn, PJ
A1  - Beumer, D
A1  - Staals, J
A1  - Boiten, J
A1  - Wermer, MJH
A1  - Kappelle, LJ
A1  - Van Dijk, EJ
A1  - Schonewille, WJ
A1  - Hofmeijer, J
A1  - Van Oostayen, JA
A1  - Vroomen, PC
A1  - De Kort, PLM
A1  - Keizer, K
A1  - De Bruijn, SF
A1  - Van Den Berg, JSP
A1  - Schreuder, THCML
A1  - Aerden, LAM
A1  - Flach, HZ
A1  - Visser, MC
A1  - Den Hertog, HM
A1  - Brouwer, PA
A1  - Emmer, BJ
A1  - Sprengers, MES
A1  - Van Den Berg, R
A1  - Nijeholt, GJL
A1  - Van Walderveen, MAA
A1  - Lo, RH
A1  - De Vries, J
A1  - Vos, JA
A1  - Eshghi, O
A1  - Tielbeek, AV
A1  - Van Dijk, LC
A1  - Van Hasselt, BAAM
A1  - Heijboer, RJJ
A1  - Dallinga, RJ
A1  - Bot, JCJ
A1  - Gerrits, DG
A1  - Fransen, PSS
A1  - Marquering, HA
A1  - Steyerberg, EW
A1  - Yoo, AJ
A1  - Jenniskens, SFM
A1  - Van Den Berg-Vos, RM
A1  - Karas, GB
A1  - Brown, MM
A1  - Liebig, T
A1  - Stijnen, T
A1  - Andersson, T
A1  - Mattle, H
A1  - Wahlgren, N
A1  - Van Der Heijden, E
A1  - Ghannouti, N
A1  - Fleitour, N
A1  - Hooijenga, I
A1  - Puppels, C
A1  - Pellikaan, W
A1  - Geerling, A
A1  - Lindl-Velema, A
A1  - Van Vemde, G
A1  - Klinieken, I
A1  - De Ridder, A
A1  - Greebe, P
A1  - De Bont-Stikkelbroeck, J
A1  - De Meris, J
A1  - Janssen, K
A1  - Struijk, W
A1  - Licher, S
A1  - Boodt, N
A1  - Ros, A
A1  - Venema, E
A1  - Slokkers, I
A1  - Ganpat, RJ
N2  - IMPORTANCE: 
It is uncertain whether therapeutic reperfusion with endovascular treatment yields more or less brain edema. OBJECTIVE To elucidate the association between reperfusion and brain edema. The secondary objectives were to evaluate whether brain edema could partially be responsible for worse outcomes in patients with later reperfusion or lower Alberta Stroke Program Early Computed Tomography Score. 

DESIGN, SETTING, AND PARTICIPANTS: 
This was a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), which was a prospective, randomized, multicenter clinical trial of endovascular treatment compared with conventional care of patients with acute anterior circulation ischemic stroke. Of 502 patients enrolled from December 2010 to June 2014, 2 patients declined to participate. Additionally, exclusion criteria were absence of follow-up imaging or presence of parenchymal hematoma, resulting in 462 patients included in this study. Brain edema was assessed retrospectively, from December 10, 2016, to July 24, 2017, by measuring midline shift (MLS) in all available follow-up scans. Observers were blinded to clinical data. 

MAIN OUTCOMES AND MEASURES: 
Midline shift was assessed as present or absent and as a continuous variable. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score in the endovascular treatment arm. The modified arterial occlusive lesion score was used to evaluate the recanalization status in both arms. The modified Rankin scale score at 90 days was used for functional outcome. RESULTS Of 462 patients, the mean (SD) age was65 (11) years, and 41.8% (n = 193) were women. Successful reperfusion and recanalization were associated with a reduced likelihood of having MLS (adjusted common odds ratio, 0.25; 95% CI, 0.12-0.53; P < .001 and adjusted common odds ratio, 0.34; 95% CI, 0.21-0.55; P < .001, respectively). Midline shift was partially responsible for worse modified Rankin scale scores in patients without reperfusion or recanalization (MLS changed the logistic regression coefficients by 30.3% and 12.6%, respectively). In patients with delayed reperfusion or lower Alberta Stroke Program Early Computed Tomography Score, MLS mediated part of the worse modified Rankin scale scores, corresponding to a change in the regression coefficient of 33.3% and 64.2%, respectively. 

CONCLUSIONS AND RELEVANCE: 
Successful reperfusion was associated with reduced MLS. This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction.
ID  - discovery10047835
UR  - http://dx.doi.org/10.1001/jamaneurol.2017.5162
SN  - 2168-6149
IS  - 4
TI  - Association of reperfusion with brain edema in patients with acute ischemic stroke: A secondary analysis of the MR CLEAN Trial
AV  - restricted
Y1  - 2018/04//
VL  - 75
SP  - 453
EP  - 461
ER  -