Highlights
- •This is a prospective randomized controlled study in posterior circulation stroke patients.
- •High-flow adjuvant normobaric oxygen therapy was safe after vessel recanalization.
- •No significant neuroprotection of normobaric oxygen was suggested in the study.
- •A favorable prognosis outcome after basilar thrombectomy was achieved in the study.
- •The criteria of RCT on basilar thrombectomy may need be reconsidered in the future.
Abstract
Background
Recent studies suggest only a third of posterior circulation stroke patients have
a good functional outcome with a high mortality after mechanical thrombectomy. To
mitigate mortality rates and increase functional outcomes, we investigated the safety
and efficacy of high-flow, normobaric oxygen (NBO) after endovascular recanalization
in posterior circulation stroke.
Methods
This is a prospective randomized controlled study. Eligible patients were randomized
to receive high-flow NBO by a Venturi mask (FiO2 50%, flow 15 L/min) or routine low-flow oxygen supplementation by nasal cannula (flow
3 L/min) after vessel recanalization for 6 h. Patient demographics, procedural metrics,
complications, functional outcomes, symptomatic intracranial hemorrhage (sICH), and
infarct volume were assessed.
Results
While we assessed 122 patients for eligibility, 87 patients were randomly assigned
(44 patients to the NBO group). Post operatively there was no significant difference
in distribution of global disability scores on the mRS at 90 days or functional independence
between the two groups. We did observe a trend suggesting reduced mortality at 90 days
with reduced infarct volume in the NBO group, however this was not statistically significant.
No significant differences were seen in the rate of sICH, pneumonia or urinary infection
between the two groups. When comparing our results with the BASICS and BEST study,
our study did reveal a significantly better prognosis after endovascular therapy.
Conclusion
Our results indicate that high-flow adjuvant NBO therapy was safe. However, the current
study does not provide evidence for a significant neuroprotection effect in posterior
circulation stroke patients after endovascular recanalization.
Keywords
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References
- Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.Lancet. 2016; 387: 1723-1731
- Wake-up stroke: Dawn of a new era.Brain Circ. 2016; 2: 72-79
- Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial.Lancet. Neurol. 2020; 19: 115-122
- Endovascular therapy for stroke due to basilar-artery occlusion.N. Engl. J. Med. 2021; 384: 1910-1920
- Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry.JAMA Neurol. 2020; 77: 561-573
- Outcomes and complications of endovascular mechanical Thrombectomy in the treatment of acute posterior circulation occlusions: a systematic review.World Neurosurg. 2021; 145: 35-44
- Reconsidering neuroprotection in the reperfusion era.Stroke. 2017; 48: 3413-3419
- Ethanol and normobaric oxygen: novel approach in modulating pyruvate dehydrogenase complex after severe transient and permanent ischemic stroke.Stroke. 2015; 46: 492-499
- Pyruvate dehydrogenase complex in cerebral ischemia-reperfusion injury.Brain Circ. 2016; 2: 61-66
- Effects of normobaric oxygen and melatonin on reperfusion injury: role of cerebral microcirculation.Oncotarget. 2015; 6: 30604-30614
- Effects of normobaric oxygen on the progression of focal cerebral ischemia in rats.Exp. Neurol. 2013; 249: 33-38
- Normobaric oxygen inhibits AQP4 and NHE1 expression in experimental focal ischemic stroke.Int. J. Mol. Med. 2019; 43: 1193-1202
- A review of oxygen therapy in ischemic stroke.Neurol. Res. 2007; 29: 173-183
- Adjuvant high-flow normobaric oxygen after mechanical thrombectomy for anterior circulation stroke: a randomized clinical trial.Neurotherapeutics. 2021; 18: 1188-1197
- Quantifying the value of stroke disability outcomes: WHO global burden of disease project disability weights for each level of the modified Rankin scale.Stroke. 2009; 40: 3828-3833
- Rethinking thrombolysis in cerebral infarction 2b: which thrombolysis in cerebral infarction scales best define near complete recanalization in the modern thrombectomy era?.Stroke. 2017; 48: 2488-2493
- A pilot study of Normobaric oxygen therapy in acute ischemic stroke.Stroke. 2005; 36: 797-802
- A modified poisson regression approach to prospective studies with binary data.Am. J. Epidemiol. 2004; 159: 702-706
- The effect of normobaric oxygen in patients with acute stroke: a systematic review and meta-analysis.Neurol. Res. 2018; 40: 433-444
- Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial.Stroke. 1999; 30: 2033-2037
- Association between post-procedural hyperoxia and poor functional outcome after mechanical thrombectomy for ischemic stroke: an observational study.Ann. Intensive Care. 2019; 9: 59
- Effect of extended CT perfusion acquisition time on ischemic core and penumbra volume estimation in patients with acute ischemic stroke due to a large vessel occlusion.PLoS One. 2015; 10e0119409
- New clinically feasible 3T MRI protocol to discriminate internal brain stem anatomy.AJNR Am. J. Neuroradiol. 2016; 37: 1058-1065
Article info
Publication history
Published online: July 24, 2022
Accepted:
July 19,
2022
Received in revised form:
May 12,
2022
Received:
March 28,
2022
Identification
Copyright
© 2022 Published by Elsevier B.V.
