{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:31:55Z","timestamp":1792794715276,"version":"4.5.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EU Horizon 2020 research and innovation programme","award":["754640"],"award-info":[{"award-number":["754640"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Several recent trials have shown improved functional outcomes with endovascular thrombectomy (EVT) in patients presenting with large ischaemic lesions, yet the impact of reperfusion on lesion pathophysiology in this population remains incompletely understood. We hypothesised that EVT reduces ischaemic oedema formation and that attenuation of oedema mediates functional outcome improvement beyond changes in lesion extent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the randomised TENSION trial, which enrolled patients with anterior circulation ischaemic stroke and baseline ASPECTS 3\u20135. Oedema progression was quantified as the change in CT-based net water uptake between baseline and follow-up non-contrast CT (\u0394NWU), derived from relative hypoattenuation within the infarct. Lesion extent change was assessed by the difference in ASPECTS between baseline and follow-up imaging (\u0394ASPECTS). Associations of \u0394NWU and \u0394ASPECTS with 90-day modified Rankin Scale (mRS) were tested using ordinal logistic regression. Mediation analyses estimated the proportion of EVT\u2019s treatment effect on functional outcome explained by \u0394NWU and \u0394ASPECTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 177 patients, median follow-up NWU was 28.5% (IQR: 19.2\u201336.6) and follow-up ASPECTS was 2 (IQR: 1\u20133). EVT was associated with substantially lower oedema progression (\u0394NWU 4.7% vs 15.9% without EVT; P\u00a0&amp;lt;\u00a0.001). Mediation analysis suggested that a model-estimated 34% of EVT-related improvement in mRS was associated with reduced oedema formation (\u0394NWU), whereas 14% was associated with lesion extent change (\u0394ASPECTS). In a sensitivity analysis using nonparametric bootstrap with 5000 resamples, the mediation signal remained robust for \u0394NWU but was substantially weaker for \u0394ASPECTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In large-core stroke, EVT was associated with significantly attenuated oedema progression between baseline and follow-up imaging. Reduced ischaemic water uptake was strongly associated with EVT benefit on 90-day functional outcome in mediation models, supporting oedema attenuation as a plausible mechanistic pathway of EVT benefit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag055","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:25:12Z","timestamp":1780593912000},"source":"Crossref","is-referenced-by-count":5,"title":["Oedema reduction mediates thrombectomy benefit in large core stroke: secondary analysis of the TENSION trial"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7575-9850","authenticated-orcid":false,"given":"Gabriel","family":"Broocks","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"Department of Neuroradiology, HELIOS Medical Center, University Campus of MSH 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