https://doi.org/10.1140/epjs/s11734-026-02133-0
Regular Article
Dynamics of net water uptake as a biomarker for cerebral edema following endovascular thrombectomy in acute ischemic stroke: association with reperfusion success and clinical outcomes
1
Department of Neurological Diseases, Privolzhsky Research Medical University, 1 Minin Street, 603005, Nizhny Novgorod, RF, Russia
2
Clinical Hospital 10, Nizhny Novgorod, Russia
3
Department of Biology, Saratov State University, Saratov, Russia
4
Department of Neurology, University of New Mexico, School of Medicine, Albuquerque, USA
5
Lovelace Biomedical Research Institute, Albuquerque, NM, USA
6
Department of Physiology, New York Medical College, Valhalla, NY, USA
a
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Received:
26
December
2025
Accepted:
10
January
2026
Published online:
13
March
2026
Abstract
This retrospective study aimed to evaluate the dynamics of cerebral edema, quantified by net water uptake (NWU), in relation to endovascular thrombectomy (EVT) outcomes using the extended Thrombolysis in Cerebral Infarction (eTICI) scale and treatment results in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). 93 patients (44 men, 49 women; median age 68.7 years) underwent EVT within 6 h of AIS onset, with NWU calculated from non-contrast CT based on perfusion CT data using the formula: NWU = (1 − Dischemia/Dnormal) × 100%. Successful recanalization (eTICI 3, 2C, 2B-67, or 2B-50) was achieved in 54 patients, while 39 had unsuccessful outcomes (eTICI 0–2A). Median NWU at admission was significantly lower in the successful group (3.1% [1.2–6.2]) compared to the unsuccessful group (5.6% [4.6–6.7]; p < 0.05). Follow-up NWU (mean 21.3 h post-EVT) was 5.4% [4.7–7.3] in successful cases versus 13.2% [11.9–14.2] in unsuccessful cases (p < 0.001). Successful EVT was associated with reduced cerebral edema, better modified Rankin Scale scores, lower mortality (14.8% vs. 38.4%; p < 0.05), and factors including lower NWU, M1 thrombus location, and fewer maneuvers. These findings highlight the positive impact of successful reperfusion on brain tissue hydration and AIS outcomes.
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© The Author(s), under exclusive licence to EDP Sciences, Springer-Verlag GmbH Germany, part of Springer Nature 2026
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
