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

Stroke. 2024 Dec;55(12):2896-2900. doi: 10.1161/STROKEAHA.124.047674. Epub 2024 Nov 11.

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.

Keywords: brain edema; cerebral infarction; ischemic postconditioning; stroke; thrombectomy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Edema / diagnostic imaging
  • Brain Edema / etiology
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / surgery
  • Cohort Studies
  • Endovascular Procedures* / methods
  • Female
  • Humans
  • Ischemic Postconditioning* / methods
  • Ischemic Stroke* / diagnostic imaging
  • Ischemic Stroke* / surgery
  • Male
  • Middle Aged
  • Prospective Studies
  • Retrospective Studies
  • Thrombectomy* / methods
  • Treatment Outcome