Zhonghua Yi Xue Za Zhi. 2026 Jun 30;106(24):2476-2481. doi: 10.3760/cma.j.cn112137-20260331-00863.
ABSTRACT
Objective: To explore the mediating role of malignant brain edema (MBE) in the relationship between eosinophils and futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion (LVO) stroke. Methods: A retrospective analysis was performed on 399 patients with acute LVO who underwent mechanical thrombectomy in Department of Neurology, the Second Affiliated Hospital of Soochow University from May 2017 to January 2023, all achieving successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI)≥2b]. Patients were categorized into the ineffective recanalization group and the non-ineffective recanalization group according to the presence or absence of ineffective recanalization, and into the MBE group and the non-MBE group according to the presence or absence of MBE. Futile recanalization was defined as angiographically confirmed recanalization of the occluded vessel after thrombectomy instantly, but with a 90-day modified Rankin Scale (mRS) score of 3-6. Clinical data was collected, including demographic characteristics (age, sex), underlying diseases (hypertension, diabetes, etc.), baseline National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Score (ASPECTS), peripheral blood eosinophil count, and 90-day mRS score. Eosinophils were entered into the model as a Z-score standardized continuous variable and as a dichotomous variable using a median cutoff of 0.01×109/L(Based on this, it was divided into high eosinophil group and low eosinophil group). Multivariate logistic regression was used to analyze the association between eosinophils and MBE or futile recanalization respectively, and the association between MBE and futile recanalization. Mediation analysis was performed to verify the mediating effect of MBE. Results: Among the 399 patients, there were 229 males and 170 females under the age of (65.5±13.6) years. There were 161 cases (40.35%) in the low eosinophil group and 238 cases (59.65%) in the high eosinophil group. MBE occurred in 84 patients (21.05%), and futile recanalization occurred in 242 patients (60.65%). Multivariate logistic regression analysis showed that lower eosinophil levels were independently associated with an increased risk of MBE [continuous variable: after Z-score standardization, OR=0.185 (95%CI: 0.058-0.589, P=0.004); dichotomous variable: OR=0.136 (95%CI: 0.062-0.295, P<0.001)] and futile recanalization [continuous variable: after Z-score standardization, OR=0.621 (95%CI: 0.469-0.821, P<0.001); dichotomous variable: OR=0.206 (95%CI: 0.109-0.387, P<0.001)]; Following thrombectomy, MBE was identified as a risk factor for futile recanalization (OR=5.286, 95%CI: 2.054-13.606, P<0.001). Mediation analysis revealed that MBE partially mediated the relationship between eosinophils and futile recanalization (indirect effect β=-0.229, 95%CI:-0.688 to -0.057, P<0.001), accounting for 12.44% of the total effect. Conclusion: Reduced eosinophils are associated with an increased risk of MBE, and MBE plays a partial mediating role in the association between eosinophils and post-thrombectomy futile recanalization.
PMID:42373468 | DOI:10.3760/cma.j.cn112137-20260331-00863