Malignant cerebral edema (MCE) is a life-threatening complication after endovascular therapy (EVT) for acute ischemic stroke (AIS). In this multicenter study, we observed a specific gyral hyperdensity sign (GHS) and sought to investigate its association with MCE, analyzing the underlying factors correlated with GHS. Consecutive anterior circulation AIS patients exhibiting post-EVT hyperdensities on 24-h follow-up computed tomography were included. GHS was defined as curvilinear hyperdensities distributed along ⩾2 adjacent cerebral gyri. A total of 542 patients were enrolled. GHS was identified in 142 patients with excellent interobserver agreement (κ = 0.804). We found that GHS (OR = 1.83, 95% CI = 1.13–2.95, P = 0.014) was independently associated with MCE. Furthermore, baseline NIHSS score (OR = 1.05, 95% CI = 1.02–1.09, P = 0.003), blood glucose (OR = 1.15, 95% CI = 1.05–1.25, P = 0.002), infarct ASPECTS (OR = 0.91, 95% CI = 0.83–0.99, P = 0.024), creatinine level (OR = 3.47, 95% CI = 1.71–7.02, P < 0.001), and intracranial internal carotid artery occlusion (OR = 1.66, 95% CI = 1.09–2.55, P = 0.020) were independently correlated with GHS. These results revealed that GHS can be reliably identified and can serve as an early warning indicator for MCE.
Shen et al. (Thu,) studied this question.