Association of uric acid levels with the risk of severe CED in LVO-AIS patients after mechanical thrombectomy

Objectives Cerebral edema (CED) significantly exacerbates mortality in patients with acute ischemic stroke (AIS) and can offset the benefits of endovascular therapy. Uric acid (UA) is recognized for its potential neuroprotective properties. This study aimed to investigate the association between serum UA levels and moderate-to-severe CED in large-vessel occlusion (LVO-AIS) patients following mechanical thrombectomy (MT). Methods We retrospectively analyzed 272 patients with anterior circulation LVO-AIS who achieved successful reperfusion (mTICI grade 2b-3) after MT. Patients were categorized into mild and moderate-to-severe CED groups, Multivariate logistic regression and interaction analyses were employed to determine the relationship between UA levels and the risk of moderate-to-severe CED. Results Patients in the no-to-mild CED group exhibited significantly higher UA levels compared to the moderate-to-severe CED group (median 310.0 vs. 302.0 μmol/L; p 0.05). After adjusting for confounders (hypertension history, NIHSS, TICI, and ASPECT scores), higher UA levels were inversely correlated with moderate-to-severe CED risk (adjusted OR: 0.74; 95% CI: 0.56–0.99; p = 0.044). Interaction analysis revealed that this protective effect was more pronounced in patients with lower admission blood glucose (7.5 mmol/L), higher mTICI grades (grade 3), and a history of hypertension (all P-interaction0.06). Specifically, among patients with glucose7.5 mmol/L, those with UA ≥ 360 μmol/L had a 76% lower risk of moderate-to-severe CED (aOR: 0.24; 95% CI: 0.09–0.69; p = 0.033). Conclusion Higher serum UA levels may serve as a protective factor against moderate-to-severe CED following MT in LVO-AIS patients. This association is particularly significant in patients with lower glucose levels, optimal reperfusion (mTICI 3), and a history of hypertension.