Risk Factors Analysis and Prediction Model for Malignant Cerebral Edema Following Mechanical Thrombectomy in Patients With Large Vessel Occlusive Stroke

Background To investigate the risk factors for malignant cerebral edema (MCE) following mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke, construct a risk prediction model, and provide evidence for early intervention. Methods A retrospective study was conducted on 248 patients with LVO who underwent MT between January 2021 to December 2024 (60 cases in the MCE group and 188 cases in the non-MCE group). Independent predictive factors were identified through univariate analysis, LASSO regression, and multivariate logistic regression. A nomogram model was constructed and validated internally using the Bootstrap method (1,000 resampling). Results Independent predictive factors for MCE after MT in LVO patients were identified, including high baseline NIHSS score ( OR = 1.805), infarct core volume ( OR = 1.235), good collateral circulation was a protective factor (OR = 0.287, indicating that each one-point increase in the collateral score reduced the risk of MCE by 71.3%), high (neutrophil-to-lymphocyte ratio) NLR (OR = 5.312), and hyperglycemia ( OR = 15.445) were significant risk factors, while successful reperfusion (mTICI ≥ 2b grade, OR = 0.068) was a key protective factor. The nomogram prediction model constructed based on the above six factors demonstrated excellent discriminative ability ( AUC = 0.902, 95%CI : 0.844 - 0.959) and good calibration ( Hosmer-Lemeshow test, P = 0.906). Conclusion NIHSS score, infarct core volume, collateral circulation, NLR, and blood glucose are independent risk factors for MCE after MT, while successful reperfusion is a key protective factor. The constructed nomogram model can effectively identify high-risk patients and guide individualized interventions.