Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
Department of Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Clin Neuroradiol. 2023 Dec;33(4):973-984. doi: 10.1007/s00062-023-01296-w. Epub 2023 Jun 7.
Disturbances of blood gas and ion homeostasis including regional hypoxia and massive sodium (Na)/potassium (K) shifts are a hallmark of experimental cerebral ischemia but have not been sufficiently investigated for their relevance in stroke patients.
We report a prospective observational study on 366 stroke patients who underwent endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) of the anterior circulation (18 December 2018-31 August 2020). Intraprocedural blood gas samples (1 ml) from within cerebral collateral arteries (ischemic) and matched systemic control samples were obtained according to a prespecified protocol in 51 patients.
We observed a significant reduction in cerebral oxygen partial pressure (-4.29%, pO = 185.3 mm Hg vs. pO = 193.6 mm Hg; p = 0.035) and K concentrations (-5.49%, K = 3.44 mmol/L vs. K = 3.64 mmol/L; p = 0.0083). The cerebral Na:K ratio was significantly increased and negatively correlated with baseline tissue integrity (r = -0.32, p = 0.031). Correspondingly, cerebral Na concentrations were most strongly correlated with infarct progression after recanalization (r = 0.42, p = 0.0033). We found more alkaline cerebral pH values (+0.14%, pH = 7.38 vs. pH = 7.37; p = 0.0019), with a time-dependent shift towards more acidotic conditions (r = -0.36, p = 0.055).
These findings suggest that stroke-induced changes in oxygen supply, ion composition and acid-base balance occur and dynamically progress within penumbral areas during human cerebral ischemia and are related to acute tissue damage.
血气和离子内稳态的紊乱，包括局部缺氧和大量钠（Na）/钾（K）转移，是实验性脑缺血的一个标志，但在中风患者中，其相关性尚未得到充分研究。
我们报告了一项对 366 名接受血管内血栓切除术（EVT）治疗前循环大血管闭塞（LVO）的中风患者（2018 年 12 月 18 日至 2020 年 8 月 31 日）的前瞻性观察性研究。根据预先制定的方案，在 51 名患者中从脑侧支动脉（缺血性）和匹配的系统对照样本中获得了 1ml 的术中血气样本。
我们观察到脑氧分压显著降低（-4.29%，pO=185.3mmHg 与 pO=193.6mmHg；p=0.035）和 K 浓度降低（-5.49%，K=3.44mmol/L 与 K=3.64mmol/L；p=0.0083）。脑 Na:K 比值显著升高，与基线组织完整性呈负相关（r=-0.32，p=0.031）。相应地，脑 Na 浓度与再通后梗死进展的相关性最强（r=0.42，p=0.0033）。我们发现更多的碱性脑 pH 值（+0.14%，pH=7.38 与 pH=7.37；p=0.0019），呈时间依赖性向更酸中毒的方向变化（r=-0.36，p=0.055）。
这些发现表明，在人类脑缺血期间，缺血半影区发生了氧供应、离子组成和酸碱平衡的变化，并呈动态进展，与急性组织损伤有关。
