Arterial blood gas analysis predicts futile recanalization in mechanical thrombectomy-treated acute ischemic stroke patients: a multicenter study.

OBJECTIVE: It is known that providing recanalization alone in large vessel occlusions is not sufficient to provide a good 90-day clinical outcome. It is advocated that neuroprotection should be increased before endovascular treatment and that the penumbra should be protected from reperfusion damage after recanalization. However, the effects of blood gas parameters before and after mechanical thrombectomy on clinical outcomes are not clear. The objective of this study is to assess the effectiveness of serial blood gas measures in accurately predicting futile recanalization at an early stage. PATIENTS AND METHODS: This study is a multicenter inquiry that collected data in a prospective manner and analyzed it retrospectively. Patients with a 2b-3 thrombolysis in cerebral infarction (TICI) score after mechanical thrombectomy for recanalization were consecutively analyzed from July 2022 to March 2023. Arterial blood gas parameters, including pH, oxygen saturation (SaO2), partial carbon dioxide pressure (PaCO2), partial oxygen pressure (PaO2), lactate, and bicarbonate (HCO3), were measured at four time points: before mechanical thrombectomy treatment (preoperative), immediately after recanalization (postoperative 1st), during the 3rd hour (postoperative 3rd), and at the 5th hour (postoperative 5th). The patients were categorized into groups based on their modified Rankin Scale (mRS) scores. RESULTS: The study included 136 patients with an average age of 69.71±11.22. The postoperative 1st-hour SaO2 values were lower in the mRS 3-6 group (p=0.038). The postoperative pH and lactate mean were greater in the mRS 3-6 group than in the 0-2 group (p=0.038 and 0.018, respectively). In logistic regression, a unit rise in lactate increased poor functional outcomes 1,632 times (p=0.024). Early neurological recovery was associated with decreased postoperative 3rd-hour lactate (p=0.014). The mean postoperative PaO2 (average of 1, 2, 3 PaO2) was higher in those with symptomatic cerebral bleeding (p=0.044). CONCLUSIONS: Monitoring lactate and pH levels in AIS patients who have had mechanical recanalization can be utilized to predict mortality and morbidity, especially in the first five hours after the procedure. Graphical Abstract: https://www.europeanreview.org/wp/wp-content/uploads/Graphical-abstract-8.jpg.

Is cardioembolic stroke more frequent than expected in acute ischemic stroke due to large vessel occlusion?

INTRODUCTION: Cardioembolic and atherosclerotic occlusions are two leading causes of acute ischemic stroke with large artery occlusion. Cardioembolic cause is more frequent in strokes due to large vessel occlusion among strokes of all types. In this study, we aimed to analyze and determine the rate of cardioembolic cause in patients with LVO treated with mechanical thrombectomy. PATIENTS AND METHODS: This study is a retrospective analysis of 1,169 patients with LVO that were treated with mechanical thrombectomy in 2019. Both anterior and posterior circulation occlusions eligible for thrombectomy were included. RESULTS: Among the 1,169 patients who performed mechanical thrombectomy, there were 52.6 % males with a mean age of 63.2 ± 12.9 years and 47.4% females with a mean age of 67.4 ± 13.3 years. The average NIHSS score was 15.3 ± 4.8. The successful revascularization (mTICI 2b-3) rate was 85.2%, the 90-day good functional outcome rate (mRS 0-2) was 39.8% and mortality (mRS 6) rate was 22.9%. Most common causes of ischemic stroke were cardioembolism in 532/1,169 (45.5%), followed by 461/1,169 (39.5%) undetermined etiologies and others, 175/1,169 (15%) large vessel disease. Atrial fibrillation is found to be the most common cause of cardioembolic stroke with 76.3% incidence. We identified 11 (0.9%) acute stroke patients treated with MT who had recurrent LVO and received repeated MT. A cardioembolic cause was found to cause the recurrent LVO in 7 (63.6%) patients. CONCLUSIONS: In this retrospective study, cardioembolic source seems to constitute majority of causes in acute ischemic strokes due to large vessel occlusions. Further exploration is needed especially in cryptogenic strokes to reveal possible cardioembolic source of emboli.

Comparison of COVID-19 patients who underwent thrombectomy with those in the pre-pandemic period in terms of etiology and prognosis.

OBJECTIVE: We aimed at determining the effectiveness of mechanical thrombectomy (MT) in patients with major vessel occlusion and infected with COVID-19, evaluating its clinical outcome and comparing it with non-COVID patients. PATIENTS AND METHODS: During the pandemic, 729 patients who underwent MT in stroke centers due to Acute Ischemic Stroke (AIS) with large vessel occlusion were evaluated. This study included 40 patients with a confirmed COVID-19 diagnosis by a positive PCR test between March 11, 2020, and December 31, 2020. These patients were compared to 409 patients who underwent MT due to major vessel occlusion between March 11, 2019, and December 31, 2019. RESULTS: Of the patients with AIS who are infected with COVID-19, 62.5% were males, and all patients have a median age of 63.5 ± 14.4 years. The median NIHSS score of the COVID-19 group was significantly higher than that of the non-COVID-19 groups. Dissection was significantly more in the COVID-19 group. The mortality rates at 3 months were higher in the COVID-19 groups compared to non-COVID-19 groups. CONCLUSIONS: This study revealed an increased frequency of dissection in patients with COVID-19. COVID-19-related ischemic strokes are associated with worse functional outcomes and higher mortality rates than non-COVID-19 ischemic strokes.

The relationship between neutrophil/lymphocyte, monocyte/ /lymphocyte, platelet/lymphocyte ratios and clinical outcomes after ninety days in patients who were diagnosed as having acute ischemic stroke in the emergency room and underwent a mechanical thro.

AIM: To determine whether there was a relationship between the neutrophil/lymphocyte (NLR), monocyte//lymphocyte (MLR), and the platelet/lymphocyte ratios (PLR) measured in blood samples taken at admission and clinical outcomes (CO) on the 90th day in patients, who were diagnosed as acute ischemic stroke (AIS) in the emergency department (ED) and underwent a mechanical thrombectomy (MT). METHOD: Patients aged ≥ 18 years, who were diagnosed as AIS in the ED and underwent MT were included in the study. Patients, who received diagnostic codes of "Cerebrovascular Diseases" (CVD) according to the ICD-10 diagnostic codes were identified. One hundred fifty patients were enrolled in the study. Modified Rankin Scale (mRS) score was used to determine neurologic status on the 90th day. The patients were divided into the two groups: good and poor CO (mRS 0-2 and mRS 3-6, respectively). The groups were compared in terms of age, sex, and NIHSS, ASPECT, and mRS scores. RESULTS: The rates of successful recanalization and good CO were 81.3 % and 38.7 %, respectively. The mortality rate was 22 %. The recanalization rates in the good and poor CO groups were 100 % and 69.6 %,respectively. Recanalization was achieved in 73.6 % of those with hyperlipidaemia and 88.5 % of those without hyperlipidaemia, which was statistically significant (p = 0.034). We observed a statistically significant relationship between the clinical outcome and NLR, MLR, PLR (p < 0.05). As the result of multivariate analysis, we found only NLR as an independent risk factor for poor CO (p = 0.043). There was also a statistically significant difference between mortality and NLR, PLR (p = 0.001). CONCLUSION: We found that NLR, MLR, PLR values were associated with CO after 90 days; high rates were associated with poor CO and low rates were associated with good CO (Tab. 7, Ref. 38). Text in PDF www.elis.sk Keywords: acute ischemic stroke; neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio; platelet/ /lymphocyte ratio; thrombectomy.