Acidosis in arterial blood gas testing is associated with clinical outcomes after endovascular thrombectomy

Abstract

Background: Despite recanalization, some of the patients undergoing endovascular thrombectomy (EVT) still suffer from unfavorable outcomes. Patients with poor prognoses are often accompanied by acidosis in arterial blood gas (ABG) testing. We, therefore, explored the ABG testing results in the early phase of recanalization and analyzed their association with poor prognosis.

Patients and methods: We identified all patients with ischemic stroke and successful endovascular recanalization for anterior circulation vessel occlusion between June 2019 and May 2022. ABG testing was performed in all patients within 0-30 min and 8 h after endovascular therapy. We investigated the relationship between the ABG testing results with symptomatic intracerebral hemorrhage (sICH), hemicraniectomy, and mortality.

Results: A total of 123 patients with stroke after endovascular thrombectomy were analyzed. Of those, eight (6.5%) patients had postinterventional sICH. Acidosis was associated with sICH. Decreased ${\text{HCO}}_3^{-}$ levels and ${\text{HCO}}_3^{-}$ levels at 8 h after EVT were independently related to a higher risk of sICH. Twelve (9.8%) patients underwent hemicraniectomy for postischemic malignant edema and similar results were found for hemicraniectomy. Increased lactate at 8 h after EVT and decreased ${\text{HCO}}_3^{-}$ levels at 8 h after EVT were closely associated with hemicraniectomy. Twenty-two (17.9%) patients died within 3 months. Decreased ${\text{HCO}}_3^{-}$ levels were independently related to mortality, as were decreased pH levels at 8 h after EVT and decreased ${\text{HCO}}_3^{-}$ levels at 8 h after EVT.

Conclusion: Acidosis is associated with clinical outcomes after endovascular therapy and may help to select patients with poor prognosis in the acute early phase of recanalization.

Keywords: acidosis; arterial blood gas; hemorrhage; reperfusion; stroke; thrombectomy.