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Association between Peripheral Arterial Lactate Levels and Malignant Brain Edema Following Endovascular Treatment for
Huiyuan Wang1,2, Ruozhen Yuan1, Panpan Shen1
1Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
Aims:
To investigate the factors of postoperative malignant brain edema (MBE) in patients with acute ischemic stroke (AIS) treated with endovascular treatment (EVT).
Background:
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.
Objective:
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.
Methods:
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.
Results:
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).
Conclusion:
Early increase in PAL levels is an independent predictor of MBE after EVT in AIS patients.
Insights
Elevated peripheral arterial lactate (PAL) levels after endovascular treatment (EVT) for acute ischemic stroke (AIS) predict malignant brain edema (MBE). Early PAL monitoring can identify patients at high risk for this severe complication.
Area of Science:
- Neurology
- Critical Care Medicine
- Biomarker Research
Background:
- Malignant brain edema (MBE) is a critical complication following endovascular treatment (EVT) for acute ischemic stroke (AIS).
- Early identification of risk factors for MBE is crucial for patient management.
- Peripheral arterial lactate (PAL) levels are emerging as a potential predictive marker for MBE.
Purpose of the Study:
- To investigate the association between immediate postoperative and highest 24-hour PAL levels and MBE development in AIS patients undergoing EVT.
- To determine if PAL levels are independent predictors of MBE post-EVT.
Main Methods:
- Retrospective analysis of 227 AIS patients treated with EVT (October 2019 - October 2022).
- Serial arterial blood sampling every 8 hours post-EVT to measure PAL levels.
- Brain edema assessment via CT scans within 7 days of EVT.
Main Results:
- MBE developed in 25.6% of patients.
- Both immediate postoperative PAL (OR 1.809) and highest 24-hour PAL (OR 2.259) were independently associated with MBE.
- The highest 24-hour PAL level demonstrated good predictive value (AUC 0.780).
Conclusions:
- Early elevation in PAL levels is an independent predictor of MBE after EVT in AIS patients.
- PAL monitoring may aid in early risk stratification for MBE.
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