Contribution of Serum Lipid Profiles to Outcome After Endovascular Thrombectomy for Anterior Circulation Ischemic Stroke

Abstract

The contribution of lipids, including low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) and triglycerides (TG), to stroke outcomes is still debated. We sought to determine the impact of LDL-C concentrations on the outcome of patients with ischemic stroke in the anterior circulation who received treatment with endovascular thrombectomy (EVT). We performed a retrospective analysis of consecutive patients with acute ischemic stroke treated at a tertiary center between 2012 and 2016. Patients treated with EVT for large artery occlusion in the anterior circulation were selected. The primary endpoint was functional outcome at 3 months as measured with the modified Rankin Scale (mRS). Secondary outcome measures included hospital death and final infarct volume (FIV). Blood lipid levels were determined in a fasting state, 1 day after admission. We studied a total of 174 patients (44.8% men) with a median age of 74 years (interquartile range [IQR] 61–82) and median National Institutes of Health Stroke Scale at admission of 18 (14–22). Bridging therapy with intravenous tissue-plasminogen activator (t-PA) was administered in 122 (70.5%). The median LDL-C was 90 mg/dl (72–115). LDL-C demonstrated a U-type relationship with FIV ( p = 0.036). Eighty-three (50.0%) patients had an mRS of 0–2 at 3 months. This favorable outcome was independently associated with younger age (OR 0.944, 95% CI 0.90–0.99, p = 0.012), thrombolysis in cerebral infarction 2b-3 reperfusion (OR 5.12, 95% CI 1.01–25.80, p = 0.015), smaller FIV (0.97 per cm 3 , 95% CI 0.97–0.99, p < 0.001), good leptomeningeal collaterals (OR 5.29, 95% CI 1.48–18.9, p = 0.011), and LDL-C more than 77 mg/dl (OR 0.179, 95% CI 0.04–0.74, p = 0.018). A higher LDL-C concentration early in the course of a stroke caused by large artery occlusion in the anterior circulation is independently associated with a favorable clinical outcome at 3 months. Further studies into the pathophysiological mechanisms underlying this observation are warranted. Electronic supplementary material The online version of this article (10.1007/s12035-018-1391-3) contains supplementary material, which is available to authorized users.

Annexin A1 protects against cerebral ischemia–reperfusion injury by modulating microglia/macrophage polarization via FPR2/ALX-dependent AMPK-mTOR pathway

“…Biomarkers detected in the peripheral blood of patients could have better predictive values because they are often related to pathophysiological response to EVT recanalization. In this regard, matrix metalloprotease-9 [ 6 ] and low-density lipoprotein cholesterol [ 33 ] have been associated with clinical outcomes in EVT-treated AIS patients. Senchenkova et al [ 20 ] have shown that plasma levels of ANXA1 were lower in AIS patients than healthy controls, but the study did not link the finding to clinical outcomes of the AIS patients and those with EVT.…”

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

“…It has been reported that patients with higher cholesterol levels exhibit lower mortality after stroke [71]. High LDL-C levels early in the course of a stroke following large artery occlusion in the anterior circulation correlate with better clinical outcomes at 3 months [72]. The Basilar Artery International Cooperation Study (BASICS) found that hyperlipidemia corre- lates with better outcomes after BAO [73].…”

Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent reperfusion therapy

“…There was a discrepancy in the prognostic significance between LDL-C level and outcomes in AIS patients [ 1 – 11 ]. Some studies found that higher LDL-C level was associated with poor outcomes in AIS patients [ 1 – 3 ], while some studies found that lower LDL-C was associated with poor outcome in AIS patients [ 4 , 5 ], others failed to find a significant association between LDL-C and outcome [ 6 – 11 ]. The inconsistent results might be explained by differences in sample size, patient selection, potential confounder, outcome assessment, and different measurement times of LDL-C. Several studies suggested that LDL got oxidized into oxLDL under oxidative stress [ 19 ], and oxLDL may contribute to exacerbate free-radical damage in the acute phase of AIS [ 20 , 32 – 35 ].…”

“…Since AIS patients may suffer from enhanced free-radical damage after reperfusion therapy [ 12 , 13 ], focusing on patients with reperfusion therapy might clarify the role of LDL-C. However, previous studies on the association between LDL-C level and outcomes in AIS patients with reperfusion therapy failed to reach a consensus [ 5 – 8 ]. The conflicting conclusions may be due to the single measurement of LDL-C.…”