The Effect of Systemic Inflammatory Response on Mechanical Thrombectomy is Partly Mediated by Pre-thrombectomy Cerebral Edema in Acute Stroke Patients.

Yuan Kan, Lu Yang, Changhong Ren, Chuanhui Li, Jiali Xu, Wenting Guo, Wenbo Zhao, Xunming Ji
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Abstract

Objective: To explore the effect of baseline Systemic Inflammatory Response reflected by platelet-to-lymphocyte ratio (PLR) and pre-thrombectomy cerebral edema reflected by Net Water Uptake (NWU) on futile recanalization in patients with Acute Ischemic Stroke (AIS) after successful thrombectomy, and to investigate the potential mediating role of baseline cerebral edema.

Methods: 134 Patients with anterior circulation ischemic stroke receiving successful thrombectomy were retrospectively studied. Their demographic and clinical characteristics were collected at admission, and the NWU was quantitatively calculated based on baseline computed tomography (CT). The predictive value of PLR for futile recanalization and the relationship between PLR, NWU, and futile recanalization using mediation analysis were explored. Patients were followed up for 90 days and were divided into a futile recanalization group and a favorable prognosis group [90-day modified Rankin Scale score of 0-2].

Results: High baseline PLR, NWU, no first-pass reperfusion, and large baseline ischemic core volume were independent predictors of futile recanalization after successful thrombectomy in patients with AIS. Mediation analysis results indicate that PLR may partially mediate the occurrence of futile recanalization through NWU.

Conclusion: Baseline PLR and NWU were independent predictors of futile recanalization, and higher PLR and NWU values were associated with a higher likelihood of futile recanalization. The findings suggest that early cerebral edema reflected by a high NWU value may be a mediator of PLR-affecting prognosis.

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急性中风患者全身炎症反应对机械血栓切除术的影响部分由血栓切除术前脑水肿介导
目的方法:回顾性研究了134例成功接受血栓切除术的前循环缺血性卒中患者。入院时收集了他们的人口统计学和临床特征,并根据基线计算机断层扫描(CT)定量计算了NWU。采用中介分析法探讨了PLR对无效再通的预测价值以及PLR、NWU和无效再通之间的关系。对患者进行了为期90天的随访,并将其分为无效再通组和预后良好组(90天改良Rankin量表评分为0-2分):结果:高基线PLR、NWU、无首次再灌注和大基线缺血核心体积是AIS患者成功血栓切除后无效再通的独立预测因素。中介分析结果表明,PLR可通过NWU部分中介无效再通的发生:结论:基线PLR和NWU是无效再通的独立预测因素,PLR和NWU值越高,无效再通的可能性越大。研究结果表明,NWU值高所反映的早期脑水肿可能是PLR影响预后的介质。
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