Post‐Thrombectomy Mild Hypercapnia State Prevents Poor Outcome by Reducing Infarct Progression

Post‐Thrombectomy Mild Hypercapnia State Prevents Poor Outcome by Reducing Infarct Progression

Abstract Objective In endovascular therapy (EVT) for stroke, futile recanalization contributes to poor prognosis. Mild hypercapnia may enhance cerebral blood flow and prevent ischemia, but its impact on prognosis in successfully recanalized EVT patients is unclear. Methods We retrospectively analyze...

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Main Authors: Peng Jiang, Weitao Yu, Xu Wang, Shouxuan Gao, Yu Geng, Shunyuan Guo, Qiang shen, Longting Lin, Mark Parsons, Sheng Zhang
Format: Article
Language:English
Published: Wiley 2025-03-01
Series:Brain and Behavior
Subjects:
endovascular therapy
futile recanalization
infarct progress
mild hypercapnia
stroke prognosis
Online Access:https://doi.org/10.1002/brb3.70347
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Summary:Abstract Objective In endovascular therapy (EVT) for stroke, futile recanalization contributes to poor prognosis. Mild hypercapnia may enhance cerebral blood flow and prevent ischemia, but its impact on prognosis in successfully recanalized EVT patients is unclear. Methods We retrospectively analyzed 237 patients from the INSPIRE database who underwent successful recanalization at our center (October 2018–March 2022). Patients were grouped by post‐EVT PaCO2 levels: high (40–50 mmHg) and low (<40 mmHg). Significant infarct expansion (SIE) was defined as a decrease in ASPECTS or pc‐ASPECTS by ≥2 from initial to 3–5 days post‐EVT. Poor outcome was modified Rankin Scale score 3–6 at 90 days. Results High PaCO2 was negatively associated with SIE (OR 0.42, 95% CI 0.22 to 0.84) and poor outcome (OR 0.42, 95% CI 0.20 to 0.87). Mediation analysis showed a significant total effect of high PaCO2 on poor outcome (coefficient −0.192, 95% CI −0.345 to −0.046), including an indirect effect mediated by SIE (coefficient −0.055, 95% CI −0.10 to −0.006). These associations were consistent in anterior circulation stroke and patients without severe low PaCO2 (<30 mmHg). Conclusion Maintaining mild hypercapnia (PaCO2 40–50 mmHg) after EVT may prevent poor outcomes by reducing post‐EVT infarct progression.
ISSN:2162-3279

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