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Abstract 037: Impact of Edema Subtypes on Outcomes in Cerebral Venous Sinus Thrombosis: Definitions and Prognostic Implications
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Abstract 037: Impact of Edema Subtypes on Outcomes in Cerebral Venous Sinus Thrombosis: Definitions and Prognostic Implications

P Kalakoti, L Cruz-Criollo, A Rodriguez-Calienes, J Gao, M Galecio-Castillo, N Mohr, V Nigenda, A Mercado, J Huynh, A Manazir, …
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.037
PMCID: PMC12773859
url
https://doi.org/10.1161/SVIN.04.suppl_1.037View
Published (Version of record) Open Access

Abstract

Introduction/PurposeIdentification of admission imaging biomarkers is critical to detect patients who will not respond to acute anticoagulation alone. The study aims to characterize and assess the distinct impact of three subtypes of edema—focal vasogenic edema, focal cytotoxic edema, and global cerebral edema (GCE)—on functional outcomes in patients with cerebral venous sinus thrombosis (CVST).MethodsThis multicentric study included patients with CVST admitted to the University of Iowa Healthcare and the Instituto Nacional de Neurología y Neurocirugía (INNN) between 2004 and 2024. Neuroimaging sequences at admission were reviewed to identify cerebral edema subtypes: focal vasogenic, focal cytotoxic, and GCE. Focal vasogenic edema was identified by changes around venous clot locations, focal cytotoxic edema by changes around sites of intracerebral hemorrhage (ICH) or infarct seen on MRI FLAIR or DWI, respectively. GCE was defined by finger‐like extensions into the gray‐white junction and effacement of gyri and sulci on CT scans. The primary outcomes were poor functional status at discharge (modified Rankin Scale [mRS] 3‐6) and mortality. Multivariable regression analysis was performed to evaluate the association of edema subtypes with outcomes, adjusting for well‐known clinical confounders.ResultsThe study included 453 patients with CVST (mean age 42.84 ± 17.16 years; 65.56% women). All patients received anticoagulation at diagnosis. Among them, 242 patients had cerebral edema classified as vasogenic (27.18%), cytotoxic (36.14%), or GCE (26.7%). In multivariable analysis, after adjusting for age, clinical characteristics, and edema subtypes, both cytotoxic edema (OR = 1.84, 95% CI: 1.01‐3.37, p = 0.047) and GCE (OR = 2.76, 95% CI: 1.42‐5.37, p = 0.003) were independently associated with poor functional outcomes at discharge. None of the edema subtypes significantly impacted mortality. The predicted risk of poor functional outcomes at discharge was plotted against age for the most significant edema subtypes and clinical characteristics, as well as their combinations (Figure 1).ConclusionOur study demonstrates that the early characterization of cerebral edema subtypes can serve as an important prognostic factor for identifying high‐risk patients with CVST. GCE is strongly associated with unfavorable outcomes. Further exploration of its pathogenesis could represent a potential therapeutic target for patients who are refractory to standard acute anticoagulation treatments.
 Thrombosis Cytotoxicity Edema

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