Elevated mean platelet volume is associated with poor outcome after mechanical thrombectomy

Peng, Feng; Zheng, Weihong; Li, Fengli; Wang, Jinjing; Liu, Zhaoji; Chen, Xingyu; Xiao, Lulu; Sun, Wen; Liu, Xinfeng

doi:10.1136/neurintsurg-2016-012849

Cited by 22 publications

(19 citation statements)

References 41 publications

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“…The observed reduction in mortality does not seem to originate from differences in adverse events such as severe hemorrhagic complications but from functional benefits of MT in patients who are at high risk of developing catastrophic infarcts under medical treatment alone. Overall, these results add to previous evidence showing that, at least in the early time window, patients with large vessel stroke benefit from MT despite having poor prognostic factors such as large lesions,7 8 poor collateral circulation,21 or systemic biomarkers of poor outcome 22 23. Although the results of ongoing randomized trials studying whether MT has a therapeutic effect in patients with large established lesions will be of utmost importance, these results suggest that the severity of the hypoperfusion should not be used to exclude patients from revascularization, at least in the early therapeutic window.…”

Section: Discussionsupporting

confidence: 65%

Benefit from mechanical thrombectomy in acute ischemic stroke with fast and slow progression

Jornet

Urra

Laredo

et al. 2019

J NeuroIntervent Surg

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ObjectiveThe rate of progression of the ischemic lesion is variable in patients with stroke. We tested the hypothesis that the tissue saving effect of mechanical thrombectomy (MT) is greater in fast progressors.MethodsA single-center cohort of consecutive patients (n=242) with occlusions of the terminal internal carotid or M1 segment of the middle cerebral artery treated with MT (n=195) or best medical treatment (n=47), known time from onset, and full imaging (baseline CT perfusion and follow-up MRI) available was studied. The estimated infarct progression rate (eIPR) was calculated at baseline and patients were categorized as fast/slow progressors according to the median eIPR of 4.8 mL/hour. The primary outcome measure was the interaction between eIPR category and MT on infarct growth. The secondary outcomes assessed the effect of MT on final infarct volume and functional status in relation to the eIPR category. The safety outcomes were mortality and symptomatic intracranial hemorrhage.ResultsThe eIPR category had a modifying effect (Pi=0.017) of MT on infarct growth that was significantly reduced with MT only in fast progressors (median (IQR) 3.8 mL (−11–55) vs 41 mL (11–107) with medical treatment; p=0.009, adjusted p=0.045). There was also a significant interaction on final infarct volume (Pi=0.005), with a greater reduction after MT in fast progressors. The functional status improved with MT both in fast and slow progressors, with no significant modifying effect of eIPR category (Pi=0.201). There were also no significant interactions on safety outcomes.ConclusionMT in stroke patients with large vessel occlusion limits infarct growth more significantly in fast progressors.

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Section: Discussionsupporting

confidence: 65%

Benefit from mechanical thrombectomy in acute ischemic stroke with fast and slow progression

Jornet

Urra

Laredo

et al. 2019

J NeuroIntervent Surg

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“…Several blood biomarkers representing different pathophysiologic pathways, such as copeptin plasma levels,19 hyperglycemia,20 or elevated mean platelet volume,21 measured on admission to the emergency room, have been demonstrated to be associated with clinical outcome, mainly in cohorts treated in the pre-MT era. There is a high potential of improving specificity of predictive scores such as MT-DRAGON using blood biomarkers, and further studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours

Hassen¹,

Bricout²,

Boulouis³

et al. 2019

J NeuroIntervent Surg

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ObjectivesThe MRI-DRAGON score includes clinical and MRI parameters and demonstrates a high specificity in predicting 3 month outcome in patients with acute ischemic stroke (AIS) treated with intravenous tissue plasminogen activator (IV tPA). The aim of this study was to adapt this score to mechanical thrombectomy (MT) in a large multicenter cohort.MethodsConsecutive cases of AIS treated by MT between January 2015 and December 2017 from three stroke centers were reviewed (n=1077). We derived the MT-DRAGON score by keeping all variables of the MRI-DRAGON score (age, initial National Institutes of Health Stroke Scale score, glucose level, pre-stroke modified Rankin Scale (mRS) score, diffusion weighted imaging-Alberta Stroke Program Early CT score ≤5) and considering the following variables: time to groin puncture instead of onset to IV tPA time and occlusion site. Unfavorable 3 month outcome was defined as a mRS score >2. Score performance was evaluated by c statistics and an external validation was performed.ResultsAmong 679 included patients (derivation and validation cohorts, n=431 and 248, respectively), an unfavorable outcome was similar between the derivation (51.5%) and validation (58.1%, P=0.7) cohorts, and was significantly associated with all MT-DRAGON parameters in the multivariable analysis. The c statistics for unfavorable outcome prediction was 0.83 (95%CI 0.79 to 0.88) in the derivation and 0.8 (95%CI 0.75 to 0.86) in the validation cohort. All patients (n=55) with an MT-DRAGONscore ≥11 had an unfavorable outcome and 60/63 (95%) patients with an MT-DRAGON score ≤2 points had a favorable outcome.ConclusionThe MT-DRAGON score is a simple tool, combining admission clinical and radiological parameters that can reliably predict 3 month outcome after MT.

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“…Two studies performed prior to 1995 found no relation, but 2 subsequent studies by Butterworth and Bath 11 and Greisenegger et al 12 found that an elevated MPV was related to a worse outcome in AIS patients. Moreover, Peng et al 13 reported that an elevated MPV was related to a poor outcome in AIS patients after mechanical thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

“…OR and 95% CI values were calculated after adjusting for the following potential confounders in a multivariable logistic regression model: age, NIHSS score at admission, and fasting glucose at admission. 13 , 24 A probability value of p <0.05 was treated as statistically significant. All of the statistical analyses were implemented using R software (version 3.3.1, The R Foundation, Vienna, Austria).…”

Section: Patient and Methodsmentioning

confidence: 99%

“… 8 Studies have already confirmed the association between MPV and stroke outcome. 11 – 13 Nevertheless, previous studies of thromboembolic diseases have generally neglected PDW as a platelet index in comparison with MPV. 8 No previous study has explored the association between PDW and the prognosis of stroke after intravenous thrombolysis.…”

Section: Introductionmentioning

confidence: 99%

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Association between platelet distribution width and poor outcome of acute ischemic stroke after intravenous thrombolysis

Gao

Chen

Lyu

et al. 2018

NDT

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PurposeThe platelet distribution width (PDW) reflects the status of platelet activity and may be useful for early predictions of the clinical outcome of stroke patients. The purpose of the study was to determine the associations between PDW and clinical outcomes after intravenous thrombolysis in stroke patients.Patients and methodsAcute ischemic stroke patients who received intravenous treatment with recombinant tissue-type plasminogen activator were selected for inclusion in the retrospective cohort of this study. The relations between PDW at admission and clinical outcomes were analyzed, including a poor outcome as assessed using the modified Rankin Scale at 3 months, early neurological improvement, and any hemorrhage. The effect of PDW at admission on a poor outcome at 3 months was analyzed using a multivariable logistic regression model with adjustment for potential confounders. The optimal PDW cutoff for predicting poor outcome at 3 months was determined by analyzing the receiver operating characteristics curve.ResultsPDW was significantly higher for a good outcome than a poor outcome (p=0.005), with median (interquartile range) values of 16.2 (13.2–17.2) and 13.6 (12.5–15.9), respectively. PDW was also higher in patients with early neurological improvement than in patients without improvement (p=0.020) and did not differ between hemorrhage and nonhemorrhage patients. The association between PDW <16.05% and poor outcome remained in a multivariable logistic regression analysis, with an OR of 6.68 and a 95% CI of 1.69–26.49 (p=0.007).ConclusionResults suggest a novel hypothesis that a lower PDW may be related with a poor outcome at 3 months after intravenous thrombolysis in acute ischemic stroke patients.

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Elevated mean platelet volume is associated with poor outcome after mechanical thrombectomy

Abstract: Elevated MPV is an independent predictor of poor outcome in patients with acute anterior circulation stroke undergoing MT at 3 months.

Cited by 22 publications

References 41 publications

Benefit from mechanical thrombectomy in acute ischemic stroke with fast and slow progression

Benefit from mechanical thrombectomy in acute ischemic stroke with fast and slow progression

MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours

Association between platelet distribution width and poor outcome of acute ischemic stroke after intravenous thrombolysis

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