Application of quantitative electroencephalography in prognosis prediction after mechanical thrombectomy in acute ischemic stroke

Abstract

Objective To explore the clinical application of quantitative electroencephalography (qEEG) in predicting the early prognosis of acute ischemic stroke after mechanical thrombectomy. Methods A total of 71 patients who underwent acute ischemic stroke mechanical thrombectomy from April 2021 to September 2022 were enrolled in He'nan Provincial People's Hospital, all of them performed qEEG after surgery. Modified Rankin Scale (mRS) was used to evaluate the prognosis on the 90 d after the surgery. Univariate and multivariate backward Logistic regression analyses were used to screen risk factors for prognosis in acute ischemic stroke after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was used to predict the value of qEEG for the prognosis of neural function. Results Patients in dismal prognosis group (mRS score 3-5, n = 28) had higher NIHSS score at admission (t = 2.686, P = 0.009), higher proportion of thrombectomy performed more than 3 times (χ2 = 4.201, P = 0.040), higher values of DTABR on the affected side (t = 2.183, P = 0.032), higher ratio of DTABR on affected side/ unaffected side (t = 6.230, P = 0.000), and higher proportion of immediately Thrombolysis in Cerebral Infarction (TICI) < 2b after surgery (χ2 = 5.420, P = 0.020) compared to favorable prognosis group (mRS score 0-2, n = 43). Logistic regression analysis showed higher NIHSS score at admission (OR = 1.542, 95%CI: 1.368-1.725；P = 0.012), DTABR on affected side/unaffected side (OR = 3.428, 95%CI: 2.673-7.314; P = 0.008), percent alpha variability (PAV) grade Ⅱ (OR = 2.983, 95%CI: 2.625-4.682; P = 0.003) and grade Ⅲ (OR = 4.088, 95%CI: 3.825-5.349; P = 0.002), amplitude electroencephalography (aEEG) grade Ⅱ (OR = 2.536, 95%CI: 1.942-5.287; P = 0.005) and grade Ⅲ (OR = 3.924, 95%CI: 2.012-6.378; P = 0.003) were risk factors of dismal prognosis in acute ischemic stroke after mechanical thrombectomy. ROC curve showed the area under the curve (AUC) of NIHSS score was 0.676 (95%CI: 0.554-0.782, P = 0.000), DTABR on affected side/unaffected side was 0.887 (95%CI: 0.789-0.950, P = 0.000), the PAV was 0.760 (95%CI: 0.643-0.853, P = 0.000), aEEG was 0.778 (95%CI: 0.664-0.868, P = 0.000), and the combined indicators classification was 0.943 (95%CI: 0.861-0.984, P = 0.000). Among them, the predictive power of the combined indicators is higher than that of the NIHSS score at admission (Z = 4.150, P = 0.000), PAV (Z = 4.006, P = 0.000) and aEEG (Z = 3.462, P = 0.001). Conclusions qEEG is an effective method to predict the early prognosis of acute ischemic stroke after mechanical thrombectomy.

Keywords

• ischemic stroke
• mechanical thrombolysis
• electroencephalography
• risk factors
• logistic models
• roc curve