Abstract：
OBJECTIVE: 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).
CONCLUSIONS: Early increase in PAL levels is an independent predictor of MBE after EVT in AIS patients.
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).
CONCLUSIONS: Early increase in PAL levels is an independent predictor of MBE after EVT in AIS patients.
摘要：
目的：探讨急性缺血性脑卒中(AIS)患者血管内治疗(EVT)术后恶性脑水肿(MBE)的影响因素。
背景：MBE是AISEVT后的严重并发症，早期识别风险因素至关重要。外周动脉乳酸（PAL）水平可作为MBE的潜在预测指标。
目的：确定术后即刻PAL水平和EVT24小时内的最高PAL水平是否与AIS患者的MBE发展独立相关。
方法：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，并记录术后即刻PAL和24h内最高PAL水平。在EVT后7天内使用脑计算机断层扫描评估脑水肿。
结果：该研究包括227名患者，中位年龄为71岁，其中59.5%为男性，25.6%的患者发生MBE（58/227）。多因素logistic回归分析显示,术后即刻PAL(比值比,1.809[95%置信区间(CI)，1.215-2.693]；p=0.004）和EVT24小时内的最高PAL水平（赔率比，2.259[95%CI，1.407-3.629]；p=0.001）与MBE独立相关。根据EVT24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）。
结论：早期PAL水平升高是AIS患者EVT后MBE的独立预测因子。
背景：MBE是AISEVT后的严重并发症，早期识别风险因素至关重要。外周动脉乳酸（PAL）水平可作为MBE的潜在预测指标。
目的：确定术后即刻PAL水平和EVT24小时内的最高PAL水平是否与AIS患者的MBE发展独立相关。
方法：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，并记录术后即刻PAL和24h内最高PAL水平。在EVT后7天内使用脑计算机断层扫描评估脑水肿。
结果：该研究包括227名患者，中位年龄为71岁，其中59.5%为男性，25.6%的患者发生MBE（58/227）。多因素logistic回归分析显示,术后即刻PAL(比值比,1.809[95%置信区间(CI)，1.215-2.693]；p=0.004）和EVT24小时内的最高PAL水平（赔率比，2.259[95%CI，1.407-3.629]；p=0.001）与MBE独立相关。根据EVT24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）。
结论：早期PAL水平升高是AIS患者EVT后MBE的独立预测因子。
