{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T07:33:51Z","timestamp":1793432031955,"version":"4.5.0"},"reference-count":29,"publisher":"BMJ","issue":"e2","license":[{"start":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T00:00:00Z","timestamp":1665100800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Natural Science Research Project of the Universities of Anhui Province in China","award":["KJ2021A0843"],"award-info":[{"award-number":["KJ2021A0843"]}]},{"name":"the Scientific Research Fund Project for Talent Introduction of Yijishan Hospital, Wannan Medical College in China","award":["YR202210"],"award-info":[{"award-number":["YR202210"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2022,9,22]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To develop and validate a novel tool for predicting the development of malignant brain edema (MBE) in large vessel occlusion stroke patients after endovascular thrombectomy (EVT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a prospectively registered population of EVT patients from three comprehensive stroke centers. The population was randomly divided into two subsets (7:3): a training cohort and an internal validation cohort. External validation was performed using the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry in China (ACTUAL) database. MBE was defined as (1) hypodense parenchyma in at least 50% of the middle cerebral artery and signs of local brain swelling, and (2) a midline shift of \u22655\u2009mm at the septum pellucidum or pineal gland with obliteration of the basal cisterns. The model was constructed using logistic regression analysis. The performance of the model was examined in terms of discrimination and calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjusting for other confounders, baseline National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT (ASPECT) scores, a clinical history of hypertension, collateral status, intravenous thrombolysis before thrombectomy, fasting blood glucose, reperfusion status, and occlusion site were found to be independent predictors of MBE. These variables were combined to create the ACORNS grading scale. The areas under the curve in receiver operating curve analysis were 0.850 (95% CI 0.816 to 0.884), 0.874 (95% CI 0.821 to 0.926), and 0.785 (95% CI 0.740 to 0.829) for the training, internal validation, and external validation cohorts, respectively, indicating good discriminative performance in the validation cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The ACORNS grading scale is an accurate and easily applicable model for the prediction of the development of MBE after EVT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2022-019404","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T13:21:57Z","timestamp":1665148917000},"page":"e190-e197","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["The ACORNS grading scale: a novel tool for the prediction of malignant brain edema after endovascular thrombectomy"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2646-982X","authenticated-orcid":false,"given":"Xianjun","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The 80th Group Army Hospital of the People's Liberation Army, Weifang, Shandong Province, China"},{"name":"Department of Neurology, Medical School of Nanjing University, Nanjing, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiankun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7530-674X","authenticated-orcid":false,"given":"Zibao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfeng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yijishan Hospital of Wannan Medical 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