Background Prolonged microvascular cerebral circulation time (mCCT) after endovascular thrombectomy (EVT) may reflect microvascular cerebral circulation impairment. The associations among mCCT, the development of malignant brain edema (MBE), and the functional outcome after successful recanalization (mTICI ≥ 2b) in large vessel occlusion stroke (LVOS) remain unclear. Material and methods We performed a retrospective analysis of 358 consecutive anterior circulation LVOS patients who achieved successful EVT. mCCT was measured intraprocedurally on DSA using syngo iFlow (Siemens Healthineers). MBE was assessed on follow-up imaging within 72 h. Functional outcome was modified Rankin Scale (mRS) score ≤ 2 at 90 days. Associations were tested using logistic regression and mediation analysis. Results MBE occurred in 42 patients (11.7%). Patients with MBE had significantly prolonged mCCT (median 4.7 s, IQR: 3.6–5.4) vs those without (3.4 s, IQR: 2.8–4.2; p < 0.001). Prolonged mCCT independently predicted MBE (aOR = 2.703; 95% CI: 1.833–3.985; p < 0.001) and unfavorable outcome (mRS > 2; aOR = 3.450; 95% CI: 2.402–4.954; p < 0.001). Adding mCCT to a model (collateral status, admission NIHSS, ASPECTS) significantly improved MBE prediction discrimination (AUC 0.915 vs 0.868; p = 0.015). Mediation analysis showed MBE did not significantly mediate the mCCT-functional outcome relationship (indirect effect coefficient = 0.001, p = 0.200; proportion mediated 7.6%). Conclusions Prolonged mCCT is a potential predictor of both MBE and unfavorable functional outcome after successful EVT for LVOS. While associated with increased MBE risk, mCCT’s impact on prognosis appears largely independent of MBE. mCCT is a valuable intraprocedural biomarker for prognostication and guiding early post-EVT management. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> How does prolonged mCCT after a successful EVT relate to MBE and functional outcomes? <Emphasis Type="BoldItalic">Findings</Emphasis> Prolonged mCCT is a potential predictor of MBE and unfavorable functional outcomes. MBE does not significantly mediate mCCT’s effect on outcomes. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Intraprocedural mCCT measurement identifies high-risk patients for early intervention (e.g., intensive monitoring, osmotherapy). It directly reflects microvascular injury, offering a novel biomarker for individualized post-EVT management. Graphical Abstract

Association between microvascular cerebral circulation time, malignant brain edema and outcome after successful thrombectomy

期刊论文
发表日期：

2026年2月11日

查看全文

Yapeng Guo,
Jia Fang,
Yuepei Gao,
Peiran Zhang,
Xinyu Fan,
Huiming Chen,
Shuaiwen Chang,
Gaoshan Zhao,
Quan Yuan,
Junfeng Xu,
Bin Shi,
Zhiming Zhou,
Xianjun Huang

摘要

Background

Prolonged microvascular cerebral circulation time (mCCT) after endovascular thrombectomy (EVT) may reflect microvascular cerebral circulation impairment. The associations among mCCT, the development of malignant brain edema (MBE), and the functional outcome after successful recanalization (mTICI ≥ 2b) in large vessel occlusion stroke (LVOS) remain unclear.

Material and methods

We performed a retrospective analysis of 358 consecutive anterior circulation LVOS patients who achieved successful EVT. mCCT was measured intraprocedurally on DSA using syngo iFlow (Siemens Healthineers). MBE was assessed on follow-up imaging within 72 h. Functional outcome was modified Rankin Scale (mRS) score ≤ 2 at 90 days. Associations were tested using logistic regression and mediation analysis.

Results

MBE occurred in 42 patients (11.7%). Patients with MBE had significantly prolonged mCCT (median 4.7 s, IQR: 3.6–5.4) vs those without (3.4 s, IQR: 2.8–4.2; p < 0.001). Prolonged mCCT independently predicted MBE (aOR = 2.703; 95% CI: 1.833–3.985; p < 0.001) and unfavorable outcome (mRS > 2; aOR = 3.450; 95% CI: 2.402–4.954; p < 0.001). Adding mCCT to a model (collateral status, admission NIHSS, ASPECTS) significantly improved MBE prediction discrimination (AUC 0.915 vs 0.868; p = 0.015). Mediation analysis showed MBE did not significantly mediate the mCCT-functional outcome relationship (indirect effect coefficient = 0.001, p = 0.200; proportion mediated 7.6%).

Conclusions

Prolonged mCCT is a potential predictor of both MBE and unfavorable functional outcome after successful EVT for LVOS. While associated with increased MBE risk, mCCT’s impact on prognosis appears largely independent of MBE. mCCT is a valuable intraprocedural biomarker for prognostication and guiding early post-EVT management.

Key Points

Question How does prolonged mCCT after a successful EVT relate to MBE and functional outcomes?

Findings Prolonged mCCT is a potential predictor of MBE and unfavorable functional outcomes. MBE does not significantly mediate mCCT’s effect on outcomes.

Clinical relevance Intraprocedural mCCT measurement identifies high-risk patients for early intervention (e.g., intensive monitoring, osmotherapy). It directly reflects microvascular injury, offering a novel biomarker for individualized post-EVT management.

Graphical Abstract