Contrast Staining CT Score on Non-Contrast CT Immediately After Endovascular Thrombectomy Predicts the Need for Decompressive Craniectomy in Patients with Acute Large Artery Occlusion

Abstract Objective: Early decompressive craniectomy (DC) is often required due to malignant cerebral edema after endovascular thrombectomy (EVT) of acute anterior circulation large vessel occlusion. This study aimed to evaluate the value of quantitative contrast staining areas with immediate non-contrast CT (NCCT) after EVT to predict the need for subsequent DC. Methods: A retrospective analysis was conducted on a cohort comprising 335 individuals with acute anterior circulation large vessel occlusion undergoing EVT between January 2017 and January 2022. The supply area of the internal carotid artery in one hemisphere was divided into nine regions. A score of 1 was assigned to each region if contrast staining (CS) was observed on NCCT after EVT. The relationship between risk factors, including assumed contrast staining CT score (CSCS), and DC was evaluated using univariate and multivariate logistic regression analyses. The sensitivity, specificity, positive and negative predictive values of the CSCS in predicting the need for DC were calculated using receiver operating characteristic (ROC) curve analysis. Results: A total of 238 patients (71.0%) demonstrated CS on immediate NCCT, of which 51 (15.2%) had the need for DC. Multivariate regression analysis revealed that CSCS [odds ratio (OR) 1.63; 95% confidence interval (CI), 1.36-1.95; P < 0.001; per 1 point] and poor collateral circulation [OR, 4.90; 95% CI, 1.12-21.32; P = 0.034] were independent risk factors for predicting the need for DC. The ROC curve for the CSCS had an area under the curve of 0.838, with a cutoff value of 4.0. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.71, 0.91, 0.61, and 0.95, respectively. Conclusion: The contrast staining score based on NCCT immediately after EVT may serve as a valuable predictive tool for early DC.