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Adjuvant high-flow normobaric oxygen after mechanical thrombectomy for posterior circulation stroke: A randomized clinical trial

  • Zhe Cheng
    Affiliations
    Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
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  • Jie Gao
    Affiliations
    Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
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  • Gary B. Rajah
    Affiliations
    Department of Neurosurgery, Munson Medical Center, Traverse City, MI, USA

    Department of Neurosurgery, Munson Healthcare, Traverse City, MI, USA
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  • Xiaokun Geng
    Correspondence
    Correspondence to: X. Geng, Stroke Center, Department of Neurology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua SouthRoad, Tongzhou District, Beijing 101149, China.
    Affiliations
    Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China

    China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China

    Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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  • Yuchuan Ding
    Correspondence
    Correspondence to: Y. Ding, Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI 48201, USA.
    Affiliations
    Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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      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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