Abstract Number: Esoc2026a2410 Predictors of Malignant Brain Edema After Mechanical Thrombectomy for Ischemic Stroke Patients : A Systematic Review and Meta-Analysis

Background and aims Endovascular thrombectomy (EVT) is an effective treatment for acute ischemic stroke(AIS), and successful recanalization increases the likelihood of favorable outcomes. However, malignant brain edema (MBE) may diminish the benefits of EVT. MBE causes elevated intracranial pressure, neurological deterioration, and herniation. Risk factors for MBE after successful EVT are not well defined. This study investigated the predictors of MBE following effective reperfusion therapy. Methods A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted from inception to December 2025. Eligible studies included adults with AIS undergoing mechanical thrombectomy that reported predictors of MBE. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results A total of 41 studies were included in our analysis. A history of hypertension, IVT use, higher NIHSS score, elevated blood glucose levels, and internal carotid artery occlusion were significantly associated with an increased risk of malignant brain edema (MBE) (OR [95% CI]: 1.45 [1.14–1.85], 1.56 [1.17–2.07], 1.08 [1.06–1.09], 1.42 [1.40–1.45], and 1.87 [1.24–2.82], respectively). Conversely, higher ASPECTS scores at admission were significantly associated with a lower risk of MBE (OR [95% CI]: 0.83 [0.78–0.88]). History of diabetes mellitus and higher collateral scores were not significantly associated with MBE (OR [95% CI]: 1.02 [0.72–1.44] and 1.03 [0.80–1.32], respectively). Conclusions Hypertension, IVT use, higher NIHSS, elevated glucose, and ICA occlusion increase malignant brain edema risk after thrombectomy, whereas higher ASPECTS is protective. These predictors support early risk stratification and management. Conflict of interest Rashad G. Mohamed.nothing to disclose Amir Hegazi.nothing to disclose Mohamed Ehab Eldesoky.nothing to disclose.Mostafa Meshref.nothing to disclose