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Reduced brain oxygen response to spreading depolarization predicts worse outcome in ischaemic stroke
Nils Hecht, Daisy Haddad, Konrad Neumann, Leonie Schumm
Brain. 2024 Nov 14 [Epub ahead of print]
Spreading depolarization (SD) describes a propagating neuronal mass depolarization within the cerebral cortex that represents a mediator
of infarct development and strongly stimulates the metabolic rate of O2
consumption. Here, we investigated the influence of Spreading
Depolarization (SD) on brain tissue partial pressure of O2 (ptiO2)
within the peri-infarct tissue of patients suffering malignant
hemispheric stroke (MHS). This prospective observational trial included
25 patients with MHS that underwent decompressive hemicraniectomy
followed by subdural placement of electrodes for electrocorticography
(ECoG) and neighboring implantation of a ptiO2 probe within the
peri-infarcted cortex. Continuous side-by-side ECoG + ptiO2 recordings
were obtained for 3-6 days postoperatively and analyzed for the
occurrence of SD-independent and SD-coupled ptiO2 changes, radiological
findings, as well as their association with clinical outcome at 6
months. During the combined ECoG + ptiO2 monitoring period of 2,604
hours and among 1,022 SDs, 483 (47%) SD-coupled ptiO2 variations were
identified as biphasic (59%), hypoxic (36%) or hyperoxic (5%) ptiO2
responses that differed significantly (*p<0.0001). Among the
remaining 538/1,022 (53%) SDs, no SD-coupled ptiO2 response was
detected, which we categorized as 'No response'. The overall infarct
progression was 1.7% (IQR -2.5-10.9). Spreading Depolarization
characteristics regarding type, duration and frequency, as well as
SD-independent baseline ptiO2 had no association with outcome. In
contrast, a high occurrence rate and amplitude of SD-coupled variations
in ptiO2 were associated with improved outcome at 6 months (occurrence:
r=-0.62, *p=0.035; amplitude: r=-0.57, *p=0.024; Spearman correlation).
In conclusion, an absent or reduced ptiO2 response to SD could indicate
tissue-at-risk and help direct targeted treatment strategies in ischemic
stroke, which is further evidence that not all SDs are the same, but
that tissue responses coupled to SD such as ptiO2 contain prognostic
information. In particular, a lack of SD-coupled ptiO2 variations
appears to be a predictor of worse outcome in large hemispheric stroke.
Source: Brain : a journal of neurology
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