Deans' stroke musings: Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, July 1, 2024

Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke

So you documented a problem, WHAT THE FUCK IS THE SOLUTION TO PREVENT IT? My directors would never let me get away with describing a problem without having a possible solution in hand. I'd be fired in no time.

Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke

Sujie Zheng¹

Xinzhao Jiang²

Shunyuan Guo²^*

Zongjie Shi²^*

¹Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
²Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China

Background and purpose: Malignant cerebral edema (MCE) is one of serious complications with high mortality following endovascular treatment (EVT) for acute ischemic stroke (AIS) with large vessel occlusion. We aimed to investigate the relationship between postoperative neutrophil-to-lymphocyte ratio (NLR) and MCE after EVT.

Methods: The clinical and imaging data of 175 patients with AIS of anterior circulation after EVT were studied. Admission and postoperative NLR were determined. The presence of MCE was evaluated on the computed tomography performed 24 h following EVT. The clinical outcomes were measured using the modified Rankin Scale (mRS) at 90-day after onset. Univariate and multivariate regression analyses were used to analyze the relationship between postoperative NLR and MCE. Optimal cutoff values of postoperative NLR to predict MCE were defined using receiver operating characteristic analysis.

Results: MCE was observed in 24% of the patients who underwent EVT and was associated with a lower rate of favorable clinical outcomes at 90-day. Multivariate logistic regression analysis demonstrated that baseline Alberta Stroke Program Early CT Score (ASPECT) score (OR = 0.614, 95% CI 0.502–0.750, p = 0.001), serum glucose (OR = 1.181, 95% CI 1.015–1.374, p = 0.031), and postoperative NLR (OR = 1.043, 95% CI 1.002–1.086, p = 0.041) were independently associated with MCE following EVT for AIS with large vessel occlusion. Postoperative NLR had an area under the receiver operating characteristic curve of 0.743 for prediction MCE, and the optimal cutoff value was 6.15, with a sensitivity and specificity of 86.8% and 55%.

Conclusion: Elevated postoperative NLR is independently associated with malignant brain edema following EVT for AIS with large vessel occlusion, and may serve as an early predictive indicator for MCE after EVT.

Introduction

Malignant cerebral edema (MCE) is one of common complications with high mortality following endovascular treatment (EVT) for acute ischemic stroke (AIS) with large vessel occlusion. The mechanism and development of cerebral edema are complex, and identifying factors that influence its formation and exploring early predictive markers are of significant clinical importance for preventing the development of MCE and improving clinical outcomes.

Previous research on predicting cerebral edema after stroke has largely focused on clinical characteristics and imaging indicators, such decreased level of consciousness, nausea or vomiting, and heavy smoking, age, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline ASPECT score, collateral circulation score (1, 2). However, these indicators do not fully reflect the mechanisms underlying the development of cerebral edema. In recent years, the neutrophil-to-lymphocyte ratio (NLR), a biomarker reflecting the pathophysiological mechanisms of stroke, has been shown to be a valuable tool for predicting stroke prognosis. Brooks et al. (3) reported a significant correlation between NLR and clinical outcomes following EVT, elevated admission NLR being associated with poor outcomes and mortality. Goyal et al. (4) demonstrated a significant correlation between lower admission NLR and favorable outcomes and functional independence at 3 months for AIS patients. However, it remains unclear whether the NLR, as an inflammatory biomarker, is involved in the development of cerebral edema and whether it can serve as an early predictive marker for MCE following EVT for AIS with large vessel occlusion.

Therefore, this study aims to explore the relationship between NLR and malignant cerebral edema following endovascular treatment for AIS with large vessel occlusion.