Neuroprotective Effects of Rapid Local Ischemic Postconditioning in Successful Endovascular Thrombectomy Patients.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2024-11-11 DOI:10.1161/STROKEAHA.124.047674

Jiangshan Deng, Guangchen He, Tingyu Yi, Liming Wei, Haitao Lu, Qing Zhou, Ye Yao, Chengcheng Zhu, Michael R Levitt, Mahmud Mossa-Basha, Haibo Yang, Yi Shen, Feng Shi, Duolao Wang, Longting Lin, Mark Parsons, Wenhuo Chen, Yueqi Zhu

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Abstract

Background: We aim to assess the efficacy of rapid local ischemic postconditioning (RL-IPostC) following successful reperfusion in patients with acute ischemic stroke with anterior circulation large vessel occlusion who underwent endovascular thrombectomy.

Methods: We conducted an ambidirectional cohort study with 78 prospectively enrolled patients with RL-IPostC and endovascular thrombectomy and 129 retrospectively enrolled patients with endovascular thrombectomy. The RL-IPostC procedure involved 5 cycles of 15-s balloon inflation and deflation in the ipsilateral internal carotid artery. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0 to 2. Secondary outcomes included excellent outcomes (modified Rankin Scale score, 0-1) and early therapeutic response. Imaging outcomes involved infarct volume changes and cerebral edema measurements. Outcomes were compared with postpropensity score matching (1:1) and assessed using univariable and multivariable regression models.

Results: In the matched cohort of 136 patients (mean age, 71±14 years; 70 men [51%]), RL-IPostC was associated with a higher rate of functional independence (adjusted odds ratio, 2.47 [95% CI, 1.10-5.68]; P=0.030). The RL-IPostC group exhibited significantly reduced infarct volumes at 24 hours (difference, -12.2 [95% CI, -23.9 to -0.53]; P=0.041) and less infarct growth (difference, -12.2 [95% CI, -23.9 to -0.45]; P=0.042). Furthermore, RL-IPostC correlated with lower increases in net water uptake (difference, -0.04 [95% CI, -0.07 to -0.01]; P=0.018), lower decrease cerebrospinal fluid volume (difference, -7.75 [95% CI, -11.7 to -3.84]; P<0.001), and reduced midline shift at 24 hours (difference, -1.39 [95% CI, -2.48 to -0.30]; P=0.013).

Conclusions: RL-IPostC tends to promote functional independence and reduces infarct growth and cerebral edema in patients with acute ischemic stroke post-reperfusion.

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快速局部缺血后条件对血管内血栓切除术成功患者的神经保护作用

背景：我们旨在评估接受血管内血栓切除术的前循环大血管闭塞急性缺血性卒中患者成功再灌注后快速局部缺血后调节（RL-IPostC）的疗效：我们进行了一项双向队列研究，前瞻性纳入了 78 名接受 RL-IPostC 和血管内血栓切除术的患者，并回顾性纳入了 129 名接受血管内血栓切除术的患者。RL-IPostC 过程包括在同侧颈内动脉进行 5 个周期、每次 15 秒的球囊充气和放气。主要结果是功能独立性，即改良Rankin量表评分为0至2分。次要结果包括优秀结果（改良Rankin量表评分，0-1分）和早期治疗反应。成像结果包括梗死体积变化和脑水肿测量。结果与后倾向评分匹配（1:1）进行了比较，并使用单变量和多变量回归模型进行了评估：在 136 名患者（平均年龄为 71±14 岁；70 名男性 [51%]）的匹配队列中，RL-IPostC 与更高的功能独立率相关（调整后的几率比为 2.47 [95% CI，1.10-5.68]；P=0.030）。RL-IPostC 组在 24 小时内的梗死体积明显缩小（差异为 -12.2 [95% CI, -23.9 to -0.53]；P=0.041），梗死增生也较少（差异为 -12.2 [95% CI, -23.9 to -0.45]；P=0.042）。此外，RL-IPostC还与净摄水量增加较低（差异，-0.04 [95% CI，-0.07至-0.01]；P=0.018）、脑脊液容量减少较低（差异，-7.75 [95% CI，-11.7至-3.84]；PP=0.013）相关：结论：RL-IPostC可促进急性缺血性脑卒中再灌注后患者的功能独立，减少梗死增生和脑水肿。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.