Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Immunol. 2022 May 3;13:835915. doi: 10.3389/fimmu.2022.835915. eCollection 2022.
Acute basilar artery occlusion (ABAO) is known to have a poor outcome with a high rate of morbidity and mortality despite endovascular treatment (EVT), highlighting the necessities of exploring factors to limit the efficacy of EVT in these patients. Cerebellar infarctions in ABAO might progress to malignant cerebellar edema (MCE), a life-threatening complication after reperfusion, posing a secondary injury to the brainstem by mass effects. Therefore, the present research aimed to explore the impacts of MCE on a long-term outcome and investigate the prognostic factors for MCE among ABAO after EVT.
In the national BASILAR registry, a total of 329 ABO patients with cerebellar infarctions treated by EVT met the inclusion criteria. The presence of MCE defined by the Jauss scale ≥4 points, was evaluated on the computed tomography performed 72 h after EVT. The adjusted odds ratio and 95% CI were obtained by logistic regression models. A favorable outcome was defined as a 90-day modified Rankin Scale score of 0-3.
MCE was statistically associated with the decreased incidence of a favorable outcome [adjusted odds ratio, 0.35(95% CI, 0.18-0.68), P=0.002]. The baseline National Institutes of Health Stroke Scale score, collateral circulation, neutrophil count at admission, and recanalization status were predictors for MCE and a favorable functional status at 90 days (all P<0.05). Among all inflammatory factors, the neutrophil count achieved the highest accuracy, sensitivity, and specificity for MCE. Adding the neutrophil count status into the baseline model obviously enhanced its prediction ability for MCE and favorable outcome by increasing the area under curve and achieving both net reclassification and integrated discrimination improvement (all P<0.05). Mediation analysis indicated that MCE mediated the association between the increased neutrophil count and worse functional outcome (P=0.026).
MCE acted essential roles in worsening prognosis for ABAO after EVT. A high neutrophil count at admission was linked to MCE and a poor outcome among ABAO patients, which could be further incorporated into the clinical decision-making system and guide immunomodulation therapy.
尽管进行了血管内治疗（EVT），急性基底动脉闭塞（ABAO）的预后仍然很差，发病率和死亡率都很高，这突显了探索限制这些患者 EVT 疗效的因素的必要性。ABAO 中的小脑梗死可能进展为恶性小脑水肿（MCE），这是再灌注后的一种危及生命的并发症，通过质量效应对脑干造成继发性损伤。因此，本研究旨在探讨 MCE 对长期预后的影响，并研究 EVT 后 ABO 中 MCE 的预后因素。
在全国 BASILAR 登记处，共有 329 名接受 EVT 治疗的 ABO 小脑梗死患者符合纳入标准。在 EVT 后 72 小时进行的计算机断层扫描上评估 Jauss 量表≥4 分的 MCE 存在情况。通过逻辑回归模型获得调整后的优势比和 95%置信区间。90 天改良 Rankin 量表评分 0-3 定义为预后良好。
MCE 与预后不良发生率降低呈统计学相关[调整后的优势比，0.35（95%置信区间，0.18-0.68），P=0.002]。基线国立卫生研究院卒中量表评分、侧支循环、入院时的中性粒细胞计数和再通状态是 MCE 和 90 天功能状态良好的预测因素（均 P<0.05）。在所有炎症因子中，中性粒细胞计数对 MCE 的准确性、敏感性和特异性最高。将中性粒细胞计数状态添加到基线模型中，通过增加曲线下面积并实现净重新分类和综合判别改善，明显提高了 MCE 和预后良好的预测能力（均 P<0.05）。中介分析表明，MCE 介导了入院时中性粒细胞计数增加与功能结局恶化之间的关联（P=0.026）。
MCE 在 EVT 后 ABO 的预后恶化中起着重要作用。入院时的高中性粒细胞计数与 ABO 患者的 MCE 和不良结局相关，这可能进一步纳入临床决策系统并指导免疫调节治疗。
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