Distinct Alterations in Oxygenation, Ion Composition and Acid-Base Balance in Cerebral Collaterals During Large-Vessel Occlusion Stroke.
Clin Neuroradiol
; 33(4): 973-984, 2023 Dec.
Article
in En
| MEDLINE
| ID: mdl-37284875
ABSTRACT
PURPOSE:
Disturbances of blood gas and ion homeostasis including regional hypoxia and massive sodium (Na+)/potassium (K+) shifts are a hallmark of experimental cerebral ischemia but have not been sufficiently investigated for their relevance in stroke patients.METHODS:
We report a prospective observational study on 366 stroke patients who underwent endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) of the anterior circulation (18 December 2018-31 August 2020). Intraprocedural blood gas samples (1â¯ml) from within cerebral collateral arteries (ischemic) and matched systemic control samples were obtained according to a prespecified protocol in 51 patients.RESULTS:
We observed a significant reduction in cerebral oxygen partial pressure (-4.29%, paO2ischemicâ¯= 185.3â¯mmâ¯Hg vs. paO2systemicâ¯= 193.6â¯mmâ¯Hg; pâ¯= 0.035) and K+ concentrations (-5.49%, K+ischemicâ¯= 3.44â¯mmol/L vs. K+systemicâ¯= 3.64â¯mmol/L; pâ¯= 0.0083). The cerebral Na+K+ ratio was significantly increased and negatively correlated with baseline tissue integrity (râ¯= -0.32, pâ¯= 0.031). Correspondingly, cerebral Na+ concentrations were most strongly correlated with infarct progression after recanalization (râ¯= 0.42, pâ¯= 0.0033). We found more alkaline cerebral pH values (+0.14%, pHischemicâ¯= 7.38 vs. pHsystemicâ¯= 7.37; pâ¯= 0.0019), with a time-dependent shift towards more acidotic conditions (râ¯= -0.36, pâ¯= 0.055).CONCLUSION:
These findings suggest that stroke-induced changes in oxygen supply, ion composition and acid-base balance occur and dynamically progress within penumbral areas during human cerebral ischemia and are related to acute tissue damage.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Arterial Occlusive Diseases
/
Brain Ischemia
/
Stroke
/
Endovascular Procedures
/
Ischemic Stroke
Type of study:
Observational_studies
Limits:
Humans
Language:
En
Journal:
Clin Neuroradiol
Journal subject:
NEUROLOGIA
/
RADIOLOGIA
Year:
2023
Document type:
Article
Affiliation country:
Germany