Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
Department of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui, China.
Curr Neurovasc Res. 2024;20(5):535-543. doi: 10.2174/0115672026283642231212061910.
To investigate the factors of postoperative malignant brain edema (MBE) in patients with acute ischemic stroke (AIS) treated with endovascular treatment (EVT).
MBE is a severe complication following EVT for AIS, and it is essential to identify risk factors early. Peripheral arterial lactate (PAL) levels may serve as a potential predictive marker for MBE.
To determine whether immediate postoperative PAL levels and the highest PAL level within 24 hours of EVT are independently associated with MBE development in AIS patients.
We retrospectively analyzed patients with AIS who underwent EVT from October 2019 to October 2022. Arterial blood was collected every 8 h after EVT to measure PAL, and record the immediate postoperative PAL and the highest PAL level within 24 h. Brain edema was evaluated using brain computed tomography scans within 7 days of EVT.
The study included 227 patients with a median age of 71 years, of whom 59.5% were male and MBE developed in 25.6% of patients (58/227). Multivariate logistic regression analysis showed that the immediate postoperative PAL (odds ratio, 1.809 [95% confidence interval (CI), 1.215-2.693]; p = 0.004) and the highest PAL level within 24 h of EVT (odds ratio, 2.259 [95% CI, 1.407-3.629]; p = 0.001) were independently associated with MBE. The area under the curve for predicting MBE based on the highest PAL level within 24 hours of EVT was 0.780 (95% CI, 0.711-0.849).
Early increase in PAL levels is an independent predictor of MBE after EVT in AIS patients.
探讨血管内治疗（EVT）后急性缺血性脑卒中（AIS）患者术后恶性脑水肿（MBE）的相关因素。
MBE 是 EVT 后 AIS 的严重并发症，早期识别风险因素至关重要。外周动脉乳酸（PAL）水平可能是 MBE 的潜在预测标志物。
确定 EVT 后即刻 PAL 水平和 24 小时内的最高 PAL 水平是否与 AIS 患者 MBE 的发生独立相关。
我们回顾性分析了 2019 年 10 月至 2022 年 10 月接受 EVT 的 AIS 患者。EVT 后每 8 小时采集动脉血以测量 PAL，并记录 EVT 后即刻 PAL 和 24 小时内的最高 PAL 水平。EVT 后 7 天内使用脑 CT 扫描评估脑水肿。
研究共纳入 227 例患者，中位年龄 71 岁，其中 59.5%为男性，58/227（25.6%）例患者发生 MBE。多变量逻辑回归分析表明，EVT 后即刻 PAL（比值比，1.809[95%置信区间（CI），1.215-2.693]；p = 0.004）和 24 小时内的最高 PAL 水平（比值比，2.259[95%CI，1.407-3.629]；p = 0.001）与 MBE 独立相关。基于 EVT 后 24 小时内最高 PAL 水平预测 MBE 的曲线下面积为 0.780（95%CI，0.711-0.849）。
EVT 后 AIS 患者 PAL 水平早期升高是 MBE 的独立预测因素。
