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Although endovascular thrombectomy (EVT) has recognized advantages in large vessel occlusive anterior circulation stroke, more than half of the patients receiving EVT treatment at follow-up still have functional dependence
.
People are paying more and more attention to the causes of adverse outcomes and factors that reduce the efficacy of EVT
Cerebral edema is a recognized cause of secondary injury after ischemic stroke and is associated with high morbidity and mortality
.
Large hemispheric infarction (LHI) refers to an ischemic stroke in which most areas of the middle cerebral artery are widely involved, especially those who are prone to clinically significant brain swelling
The relationship between reperfusion and cerebral edema is unclear
.
In animal models, reperfusion continues to exacerbate cerebral edema
Therefore, patients with LHI (translator's note: this type of patients have a smaller ischemic penumbra) should be particularly alert to the risk of cerebral edema when undergoing EVT treatment, and the impact of reperfusion therapy on cerebral edema should be fully understood
.
In November 2021, Bruce CV Campbell from Australia and others published their patient-level meta-analysis results on Stroke, discussing the impact of EVT and reperfusion on cerebral edema and the effect of cerebral edema on the functional outcome of LHI patients
.
Included 7 randomized controlled trials published from January 1, 2010 to May 31, 2017 (these trials compared the efficacy of thrombectomy and drug therapy on anterior circulation ischemic stroke) (HERMES), the investigator A systematic review of these trials and a meta-analysis at the individual patient level were performed
.
The researchers analyzed LHI patients.
Among the 1764 patients, 177 had large-area cerebral infarction (LHI)
.
Thrombectomy and reperfusion are associated with functional improvement (thrombectomy common OR=2.
In an exploratory analysis, for patients with core volume >130ml or CT-ASPECTS score ≤3 (n=76), thrombectomy was associated with greater MLS (β=2.
76[95%CI, 0.
33-5.
20] ), but has nothing to do with functional improvement (odds ratio, 1.
71 [95% CI, 0.
24-12.
08]) (adjusted for age and NIHSS score)
.
In the end, the author believes that for patients with large hemispheric cerebral infarction, thrombectomy and reperfusion are not related to MLS, but in the subgroup with very large core volumes (>130 mL), thrombectomy and space-occupying ischemic edema caused MLS increases the correlation
.
Reducing the secondary damage mediated by cerebral edema in patients with large-area cerebral infarction may further improve the prognosis after reperfusion therapy
Original source:
Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis .
Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis In this message
