Title:Association between Peripheral Arterial Lactate Levels and Malignant Brain Edema Following Endovascular Treatment for Ischemic Stroke
Volume: 20
Issue: 5
Author(s): Huiyuan Wang, Ruozhen Yuan, Panpan Shen, Xinyue Yu, Xinyi Chen, Yafei Shang, Jie Xu, Mingming Tan, Sheng Zhang and Yu Geng*
Affiliation:
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated
People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
Keywords:
Lactate, arterial blood gas, acute ischemic stroke, endovascular treatment, malignant brain edema, prognosis.
Abstract: 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.
