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Abnormal neurological pupil index is associated with malignant cerebral edema after mechanical thrombectomy in large

Ehsan Dowlati1, Kwadwo Sarpong2, Stanley Kamande2

  • 1Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, 304-215-3107, USA. edowlati@gmail.com.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|March 30, 2021
PubMed
Abstract

Insights

Abnormal neurological pupil index (NPi) and hemorrhagic conversion are linked to malignant cerebral edema (MCE) after mechanical thrombectomy (MT) for large vessel occlusion. This finding highlights NPi as a potential objective marker for MCE risk in stroke patients.

Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Malignant cerebral edema (MCE) is a severe complication following large vessel occlusion (LVO).
  • Predictors of MCE development in LVO patients undergoing mechanical thrombectomy (MT) require further elucidation.
  • The utility of pupillometry and the neurological pupil index (NPi) as objective MCE markers in this population is unexplored.

Purpose of the Study:

  • To identify variables associated with MCE in patients undergoing MT for LVO.
  • To investigate the association between abnormal NPi and MCE development post-MT.
  • To determine if NPi can serve as an objective indicator of MCE risk.

Main Methods:

  • Retrospective analysis of 284 acute ischemic stroke patients treated with MT (2017-2020).
  • Collection of baseline and outcome data, including NPi from pupillometry within 72 hours post-MT.
  • Univariate and multivariate analyses comparing MCE and non-MCE groups.

Main Results:

  • 64 (22.5%) patients developed MCE.
  • Significant differences observed in admission glucose, NIHSS, infarct core volume, TICI score, and number of passes between groups.
  • Multivariate analysis revealed abnormal ipsilateral NPi (OR 21.80) and hemorrhagic conversion as independent predictors of MCE.

Conclusions:

  • Abnormal NPi and hemorrhagic conversion are significantly associated with MCE in patients post-MT.
  • NPi emerges as a potential objective biomarker for predicting MCE risk.
  • Further research is needed to fully define the relationship between NPi and patient outcomes after MT.
Keywords:
Cerebral edemaIschemic strokePupillary reflexPupillometryThrombectomy

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