Abstract
BackgroundEarly identification of massive middle cerebral artery infarction (MCAI) at risk for malignant MCAI (m-MCAI) may be useful in selecting patients for aggressive therapies. The aim of this study was to determine whether CYP metabolites may help to predict impending m-MCAI.MethodsThis is a prospective, two-center observational study in 256 patients with acute massive MCAI. Plasma levels of 20-hydroxyeicosatetraenoic acid (20-HETE), epoxyeicosatrienoic acids, and dihydroxyeicosatrienoic acids were measured at admission. Brain computed tomography (CT) was performed at admission and repeated between day 3 and 7, or earlier if there was neurological deterioration. The primary outcome was m-MCAI. The m-MCAI was diagnosed when follow-up brain CT detected a more than two-thirds space-occupying MCAI with midline shift, compression of the basal cisterns, and neurological worsening.ResultsIn total of 256 enrolled patients, 77 (30.1%) patients developed m-MCAI. Among the 77 patients with m-MCAI, 60 (77.9%) patients died during 3 months of stroke onset. 20-HETE level on admission was significantly higher in patients with m-MCAI than those without m-MCAI. There was an increase in the risk of m-MCAI with increase of 20-HETE levels. The third and fourth quartiles of 20-HETE levels were independent predictors of m-MCAI (OR: 2.86; 95% CI: 1.16 – 6.68; P = 0.025, and OR: 4.23; 95% CI: 1.35 – 8.26; P = 0.002, respectively).ConclusionsIncidence of m-MCAI was high in patients with massive MCAI and the prognosis of m-MCAI is very poor. Elevated plasma 20-HETE may be as a predictor for m-MCAI in acute massive MCAI, and it might useful in clinical practice in therapeutic decision making.
Highlights
Identification of massive middle cerebral artery infarction (MCAI) at risk for malignant MCAI (m-MCAI) may be useful in selecting patients for aggressive therapies
Massive middle cerebral artery infarction (MCAI) accounts for 10 to 15% of all stroke patients, which usually caused by acute occlusion of internal carotid artery or the proximal middle cerebral artery (MCA) [1, 2], and of these patients, malignant MCAI (m-MCAI) reaches 30 to 50% [2,3,4]
The present results showed that the incidence of m-MCAI was very high in patients with massive MCAI. 20-hydroxyeicosatetraenoic acid (20-HETE) level was independent predictor of m-MCAI, the odds ratio for m-MCAI increased with increase in quartiles of 20-HETE levels, this may be of use in therapeutic decision making and the timing of Decompressive hemicraniectomy (DHC) [28]
Summary
Identification of massive middle cerebral artery infarction (MCAI) at risk for malignant MCAI (m-MCAI) may be useful in selecting patients for aggressive therapies. Massive middle cerebral artery infarction (MCAI) accounts for 10 to 15% of all stroke patients, which usually caused by acute occlusion of internal carotid artery or the proximal middle cerebral artery (MCA) [1, 2], and of these patients, malignant MCAI (m-MCAI) reaches 30 to 50% [2,3,4]. Early identification or prediction of m-MCAI is very essential for timely application of DHC in patients with massive MCAI. Identification of key mechanism involved in m-MCAI and predictor for m-MCAI will be of important significance for the early diagnosis and treatment of m-MCAI among patients with massive MCAI. The underlying basic mechanisms and predictors for m-MCAI are not completely understood
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