Association of Osmotic Drugs With Clinical Outcomes in Acute Large Hemispheric Infarction

Diagnostic criteria for large hemispheric infarction (LHI): CT within 6 hours of onset showing hypointense areas > 1/3 of the middle cerebral artery territory, or hypointense areas > 50% of the middle cerebral artery territory within 6 hours to 72h of onset. LHI is strongly associated with severe cerebral edema, which can occur to varying degrees cerebral edema within hours or days of LHI. In recent years, endovascular treatment has significantly improved the revascularization of patients with large vessel occlusive cerebral infarction and reduced the incidence of malignant progression and mortality in patients with acute LHI, but many patients still suffer from malignant brain edema (MBE), which leads to the worsening of the disease.

Inclusion criteria

• Age ≥ 18 years
• Within 72 hours of onset of the stroke
• Meets the diagnostic criteria for acute ischaemic stroke in the "Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018"
• Meeting the diagnostic criteria for massive cerebral infarction in the "Guidelines for the Surgical Treatment of Massive Cerebral Infarction": CT within 6 hours of onset showing hypointense areas > 1/3 of the middle cerebral artery territory, or > 50% of the middle cerebral artery territory within 6 hours to 72 hours of onset;
• The patient consented and signed an informed consent form.

Exclusion criteria

• Women who are pregnant or breastfeeding;
• in combination with other serious comorbidities resulting in a life expectancy of less than 3 months
• Those who are allergic or intolerant to osmotic drugs;
• Those who have participated in other interventional clinical studies (which affecting the observation of outcomes in this cohort);
• Those with a previous history of stroke and significant residual neurological disability (mRS ≥ 2 points)
• Those who, in the judgment of the investigator, are not suitable for participation in this study