{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:17:23Z","timestamp":1792167443789,"version":"4.4.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Cerebral edema is a life-threatening complication of ischemic stroke that disproportionally affects patients with large established infarction. We assessed whether endovascular thrombectomy (EVT) reduces or exacerbates edema development, and the association between edema with short-term and long-term outcomes in this high-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this prespecified secondary analysis of the SELECT2 randomized clinical trial (Randomized Controlled Trial to Optimize Patient\u2019s Selection for Endovascular Treatment in Acute Ischemic Stroke), which tested the efficacy and safety of EVT versus medical management in adult patients with acute anterior circulation large vessel occlusion presenting with large ischemic core (defined as Alberta Stroke Program Early Computed Tomography Score of 3\u20135 or core volume \u226550 mL on computed tomography perfusion or diffusion magnetic resonance imaging), we assessed maximum midline shift (MLS) within 7 days of randomization between treatment groups using a probabilistic index model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      After exclusion of 10 patients who underwent hemicraniectomy before follow-up imaging, 342 patients were analyzed. The median MLS on follow-up magnetic resonance imaging or computed tomography was 6.39 mm (interquartile range, 0\u201312.0) in the EVT and 4.18 mm (interquartile range, 0\u20139.66) in medical management patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.021). EVT was independently associated with greater MLS (adjusted odds ratio, 1.63 [95% CI, 1.25\u20132.12];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.0027) after adjusting for age and core volume. There was no interaction between EVT and core volume at presentation on the association with MLS (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt;0.79). MLS was associated with the development of early neurological worsening (adjusted odds ratio, 1.15 [95% CI, 1.07\u20131.23];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), and a lower likelihood of long-term functional improvement assessed on modified Rankin Scale score at 90 days (adjusted odds ratio, 0.96 [95% CI, 0.93\u20130.98];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.0029). On mediation analysis, cerebral edema reduced the effect of EVT on functional outcome by 10.6%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Despite overall clinical benefit, EVT in patients presenting with a large ischemic core was associated with increased cerebral edema, which, in turn, was associated with early neurological worsening and worse functional outcome at 90 days. Early recognition and individualized treatment to prevent secondary injury from cerebral edema in this population are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03876457.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.054015","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:00:14Z","timestamp":1774861214000},"page":"1492-1500","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Cerebral Edema in Patients With Large Ischemic Core After Thrombectomy: A Secondary Analysis of SELECT2 Randomized Trial"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct03876457","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6973-8677","authenticated-orcid":true,"given":"Felix C.","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia (F.C.N., V.Y., G.S., P.G., S.M.D., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8814-6853","authenticated-orcid":true,"given":"Vignan","family":"Yogendrakumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia (F.C.N., V.Y., G.S., P.G., S.M.D., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2135-0504","authenticated-orcid":true,"given":"Hannah T.","family":"Johns","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne, Parkville, Australia (H.T.J., L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-6606","authenticated-orcid":true,"given":"Leonid","family":"Churilov","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne, Parkville, Australia (H.T.J., L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7148-7616","authenticated-orcid":true,"given":"Ameer E.","family":"Hassan","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley-Valley Baptist Medical Center, Harlingen (A.E.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0407-654X","authenticated-orcid":true,"given":"Michael G.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Neurology and Radiology, University of Kansas Medical Center, Kansas City (M.G.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3408-1297","authenticated-orcid":true,"given":"Santiago","family":"Ortega\u2011Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa, Iowa City (S.O.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Shazam","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cleveland Clinic, OH (M.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2412-8167","authenticated-orcid":true,"given":"Michael","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, IL (M.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9926-9840","authenticated-orcid":true,"given":"Clark W.","family":"Sitton","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, UTHealth McGovern Medical School, Houston, TX (C.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-6917","authenticated-orcid":true,"given":"Scott E.","family":"Kasner","sequence":"additional","affiliation":[{"name":"Division of Vascular Neurology, University of Pennsylvania, Philadelphia (S.E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gagan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia (F.C.N., V.Y., G.S., P.G., S.M.D., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3239-9568","authenticated-orcid":true,"given":"Prodipta","family":"Guha","sequence":"additional","affiliation":[{"name":"Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia (F.C.N., V.Y., G.S., P.G., S.M.D., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6187-894X","authenticated-orcid":true,"given":"Deep","family":"Pujara","sequence":"additional","affiliation":[{"name":"Department of Neurology, Case Western Reserve University, Cleveland, OH (D.P., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6804-3985","authenticated-orcid":true,"given":"Vitor","family":"Mendes Pereira","sequence":"additional","affiliation":[{"name":"Division of Neurology, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (V.M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-6927","authenticated-orcid":true,"given":"Maarten G.","family":"Lansberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford University, CA (M.G.L., G.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6836-102X","authenticated-orcid":true,"given":"Lawrence R.","family":"Wechsler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (L.R.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Boston Medical Center, MA (T.N.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7786-5668","authenticated-orcid":true,"given":"Johanna T.","family":"Fifi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-1543","authenticated-orcid":true,"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (M.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-043X","authenticated-orcid":true,"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Vall d\u2019Hebr\u00f3n, Barcelona, Spain (M.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8874-2487","authenticated-orcid":true,"given":"Mark W.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Newcastle, New South Wales, Australia (M.W.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0962-2300","authenticated-orcid":true,"given":"Stephen M.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia (F.C.N., V.Y., G.S., P.G., S.M.D., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3667-4248","authenticated-orcid":true,"given":"James C.","family":"Grotta","sequence":"additional","affiliation":[{"name":"Department of Neurology, Memorial Hermann Hospital Texas Medical Center, Houston (J.C.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0263-4632","authenticated-orcid":true,"given":"Gregory W.","family":"Albers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stanford University, CA (M.G.L., G.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-9433","authenticated-orcid":true,"given":"Bruce C.V.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia (F.C.N., V.Y., G.S., P.G., S.M.D., B.C.V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5726-4478","authenticated-orcid":true,"given":"Amrou","family":"Sarraj","sequence":"additional","affiliation":[{"name":"Department of Neurology, Case Western Reserve University, Cleveland, OH (D.P., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the SELECT2 Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02032-9"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2314063"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2213379"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00050-3"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214403"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2118191"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.13933"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.028287"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.30.12.2631"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X211017696"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033246"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.3745"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.27151"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930211035032"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048899"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.036104"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v059.i05"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26587"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-020-02526-5"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.49.4.1090"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.14.4.562"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1985.62.1.0031"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.25.8.1658"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.5162"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026692"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231180451"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awz057"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010049"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107913"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-60635-0"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.27235"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.036670"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201601"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1159\/000505847"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25785"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00425-3"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.59945"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231182018"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.037073"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.125.054015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:00:13Z","timestamp":1781121613000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.125.054015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":39,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1161\/STROKEAHA.125.054015"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.125.054015","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-10-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-28","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}