Neutrophil count predicts poor outcome despite recanalization after endovascular therapy

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. e467-e475 ◽  
Author(s):  
William Boisseau ◽  
Jean-Philippe Desilles ◽  
Robert Fahed ◽  
Maeva Kyheng ◽  
Kevin Zuber ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Clinical Outcome ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Neutrophil Count ◽  
Experimental Studies ◽  
Poor Clinical Outcome ◽  
High Blood Glucose ◽  
Poor Outcome ◽  
Unit Increase

ObjectiveTo identify early prognostic factors of poor clinical outcome in patients treated by endovascular therapy (EVT) with successful recanalization.MethodsWe reviewed our monocentric prospectively collected EVT database of patients with anterior circulation acute ischemic stroke (AIS) from January 2016 to April 2018 who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥ 2b) at the end of the procedure. A poor outcome was defined as a 3-month modified Rankin Scale score of ≥3.ResultsA total of 324 patients were included, among whom 186 (57.4%) had a poor outcome. Multivariate logistic regression indicated that age (per 10-year increase, odds ratio [OR] 1.34, 95% confidence interval [CI] 1.12–1.60), baseline NIH Stroke Scale score (per 1-unit increase, OR 1.09, 95% CI 1.04–1.15), initial infarct volume (per a log+1 increase, OR 1.34, 95% CI 1.05–1.67), blood glucose level (per a log+1 increase, OR 2.60, 95% CI 1.01–6.66), and neutrophil count (per 1,000-unit increase, OR 1.08, 95% CI 1.01–1.17) were all associated with poor clinical outcome.ConclusionsIn addition to baseline severe AIS criteria, high neutrophil count and high blood glucose, known from experimental studies to be associated with downstream microvascular thromboinflammation, are independently associated with poor outcome. These findings support a deleterious role of thromboinflammation in patient recovery despite successful recanalization.

Abstract P338: Incidence, Predictors and Impact of Infarct in New Territory in Escape Na1 Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nishita Singh ◽  
Martha Marko ◽  
Petra Cimflova ◽  
Johanna Ospel ◽  
Nima Kashani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Endovascular Therapy ◽  
Randomized Study ◽  
Maximum Diameter ◽  
Vascular Territory ◽  
Poor Clinical Outcome ◽  
Guide Catheter ◽  
Ct And Mri

Introduction: Infarct in new territory (INT) is a known complication of endovascular therapy. We assessed the prevalence, predictors and clinical relevance of INT Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ischemic stroke who underwent EVT within 12 hours from onset. All imaging was re-evaluated, and INT was defined by presence of infarct in new vascular territory, outside the baseline target occlusion(s) on follow up CT and MRI. INT’s were classified by maximum diameter (<2mm, 2-20mm and >20mm) and location. Results: Of 1099 analyzed patients in ESCAPE NA1, 107 had INT (9.7%, mean age 67 years, 51.4% females). There were no differences at baseline in those with vs without INT. Most INTs (75.7%) were angiographically occult and 41(38.3%) were > 20mm. The most common INT territory was the ACA alone or in combination with MCA/PCA (30.3%). The presence of emboli in new territory angiographically was significantly associated with INT (OR 16.39, 95%CI 8.14-33.09). Alteplase use, balloon guide catheter use, nerinetide and initial occlusion site did not predict INT. INT patients had higher final median infarct volumes compared to non-INT (44.5cc vs 23.3cc, P<0.001). Large INT (diameter of >20mm) were associated with poor clinical outcome compared to INT (<2mm) OR (mRS 0-2) 0.17, 95%CI 0.05-0.55). Conclusion: Infarcts in new territory are common and are associated with poor outcome.

Influence of glucose levels on clinical outcome after mechanical thrombectomy for large-vessel occlusion: a systematic review and meta-analysis

2021 ◽  
pp. neurintsurg-2021-017771
Author(s):  
Carlos Perez-Vega ◽  
Ricardo A Domingo ◽  
Shashwat Tripathi ◽  
Andres Ramos-Fresnedo ◽  
Samir Kashyap ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Clinical Outcome ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
High Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Increased Risk

Mechanical thrombectomy (MT) represents the mainstay of treatment for patients with acute ischemic stroke due to large-vessel occlusion (LVO). Intravenous thrombolysis has been associated with worse clinical outcome in patients presenting with high blood glucose levels at admission; to date the true effect of hyperglycemia in the setting of MT has not been fully elucidated. In this meta-analysis, we analyzed the influence of high blood glucose levels at admission on clinical outcome after MT. Ovid EMBASE, PubMed, Scopus, and Cochrane Library databases were searched from their dates of inception up to March 2021. An initial search identified 2118 articles representing 1235 unique studies. After applying selection criteria, three prospective and five retrospective studies were analyzed, yielding a pooled cohort of 5861 patients (2041 who presented with hyperglycemia, and 3820 who presented with normal blood glucose levels). Patients in the hyperglycemia group were less likely to have a modified Ranking Scale (mRS) score <3 (risk ratio (RR): 0.65; 95% CI 0.59 to 0.72; p<0.0001; I2=13%), and had an increased risk of symptomatic intracranial hemorrhage (sICH) (RR: 2.07; 95% CI 1.65 to 2.60; p<0.0001; I2=0%) and mortality (RR: 1.73; 95% CI 1.57 to 1.91; p<0.0001; I2=0%). Patients who present with hyperglycemia and undergo MT for treatment of LVO have an increased risk of unfavorable clinical outcome, sICH, and mortality. Glucose levels at admission appear to be a prognostic factor in this subset of patients. Further studies should focus on evaluating control of the glucose level at admission as a modifiable risk factor in patients undergoing MT for LVO.

scholarly journals Metabolome of Cerebral Thrombi Reveals an Association between High Glycemia at Stroke Onset and Good Clinical Outcome

Metabolites ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 483
Author(s):  
Laurent Suissa ◽  
Jean-Marie Guigonis ◽  
Fanny Graslin ◽  
Emilie Doche ◽  
Ophélie Osman ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Discriminant Analysis ◽  
Clinical Outcome ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Area Under The Curve ◽  
Stroke Onset ◽  
Stroke Patients ◽  
High Blood Glucose ◽  
High Blood Glucose Level

Despite the fact that glucose is the main fuel of the brain, hyperglycemia at hospital admission is generally associated with a poor functional outcome in stroke patients. This paradox may be explained by the lack of information about the blood glucose level at stroke onset. Here, we analyzed the metabolome of blood cells entrapped in cerebral thrombi to gain insight into their metabolism at stroke onset. Fourty-one consecutive stroke patients completely recanalized by mechanical thrombectomy within 6 h were included. The metabolome of retrieved thrombi was analyzed by liquid chromatography tandem with mass spectrometry. Discriminant Analysis (sparse Partial Least Squares Discriminant Analysis (sPLS-DA)) was performed to identify classification models and significant associated features of favorable clinical outcome at 3 months (modified Rankin Scale (mRS) < 2). sPLS-DA of the metabolomes of cerebral thrombi discriminated between stroke patients with a favorable or poor clinical outcome (Area Under the Curve (AUC) = 0.992 (0.931–1)). In addition, our results revealed that high sorbitol and glucose levels in the thrombi positively correlated with favorable clinical outcomes. Sorbitol, a short-term glycemic index reflecting a high blood glucose level at stroke onset, was found to be an independent predictor of good outcome (AUC = 0.908 (0.807–0.995)). This study demonstrates that a high blood glucose level at stroke onset is beneficial to the clinical outcome of the patient.

The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke

2015 ◽  
Vol 40 (5-6) ◽  
pp. 258-269 ◽  
Author(s):  
Tom van Seeters ◽  
Geert Jan Biessels ◽  
L. Jaap Kappelle ◽  
Irene C. van der Schaaf ◽  
Jan Willem Dankbaar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Predictive Value ◽  
Prognostic Value ◽  
Ct Perfusion ◽  
Patient Characteristics ◽  
Poor Clinical Outcome ◽  
Poor Outcome

Background: CT angiography (CTA) and CT perfusion (CTP) are important diagnostic tools in acute ischemic stroke. We investigated the prognostic value of CTA and CTP for clinical outcome and determined whether they have additional prognostic value over patient characteristics and non-contrast CT (NCCT). Methods: We included 1,374 patients with suspected acute ischemic stroke in the prospective multicenter Dutch acute stroke study. Sixty percent of the cohort was used for deriving the predictors and the remaining 40% for validating them. We calculated the predictive values of CTA and CTP predictors for poor clinical outcome (modified Rankin Scale score 3-6). Associations between CTA and CTP predictors and poor clinical outcome were assessed with odds ratios (OR). Multivariable logistic regression models were developed based on patient characteristics and NCCT predictors, and subsequently CTA and CTP predictors were added. The increase in area under the curve (AUC) value was determined to assess the additional prognostic value of CTA and CTP. Model validation was performed by assessing discrimination and calibration. Results: Poor outcome occurred in 501 patients (36.5%). Each of the evaluated CTA measures strongly predicted outcome in univariable analyses: the positive predictive value (PPV) was 59% for Alberta Stroke Program Early CT Score (ASPECTS) ≤7 on CTA source images (OR 3.3; 95% CI 2.3-4.8), 63% for presence of a proximal intracranial occlusion (OR 5.1; 95% CI 3.7-7.1), 66% for poor leptomeningeal collaterals (OR 4.3; 95% CI 2.8-6.6), and 58% for a >70% carotid or vertebrobasilar stenosis/occlusion (OR 3.2; 95% CI 2.2-4.6). The same applied to the CTP measures, as the PPVs were 65% for ASPECTS ≤7 on cerebral blood volume maps (OR 5.1; 95% CI 3.7-7.2) and 53% for ASPECTS ≤7 on mean transit time maps (OR 3.9; 95% CI 2.9-5.3). The prognostic model based on patient characteristics and NCCT measures was highly predictive for poor clinical outcome (AUC 0.84; 95% CI 0.81-0.86). Adding CTA and CTP predictors to this model did not improve the predictive value (AUC 0.85; 95% CI 0.83-0.88). In the validation cohort, the AUC values were 0.78 (95% CI 0.73-0.82) and 0.79 (95% CI 0.75-0.83), respectively. Calibration of the models was satisfactory. Conclusions: In patients with suspected acute ischemic stroke, admission CTA and CTP parameters are strong predictors of poor outcome and can be used to predict long-term clinical outcome. In multivariable prediction models, however, their additional prognostic value over patient characteristics and NCCT is limited in an unselected stroke population.

scholarly journals LncRNA RHPN1-AS1 promotes cholangiocarcinoma progression and predicts poor clinical outcome through miR-345-5p/YAP1 axis

2020 ◽  
Author(s):  
Lifeng Ma ◽  
Tao Li ◽  
Guochao Liu ◽  
Jianlong Wang ◽  
Zhaoqiang Yin ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Clinical Practice ◽  
Clinical Outcome ◽  
Carcinoma Cell ◽  
Poor Clinical Outcome ◽  
Xenograft Growth ◽  
Poor Outcome ◽  
New Strategies

Abstract Background LncRNAs have proven to be involved in the initiation and progression of cholangiocarcinoma (CCA), although the mechanism by which this occurs remains unknown. Methods The current study reveals that RHPN1-AS1 was overexpressed in CCA patient samples, which predicted poor outcome of CCA patients. RHPN1-AS1 increased in vitro pancreatic carcinoma cell proliferation as well as promoted xenograft growth in vivo. Mechanistically, DANCR upregulated expression of YAP1 by competitively binding to miR-345-5p. Importantly, RHPN1-AS1 level was positively correlated with YAP1 expression level in CCA tissues. Moreover, YAP1 overexpression could predicted a poor outcome of CCA patients. Results Taken together, our results suggested that RHPN1-AS1 might be a remarkable biomarker to evaluate prognosis in CCA. Conclusion The RHPN1-AS1/YAP1 axis may provide new strategies for CCA clinical practice.

Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization – When “tissue clock” and “time clock” are desynchronized

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Jawed Nawabi ◽  
Fabian Flottmann ◽  
Andre Kemmling ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Water Uptake ◽  
Quantitative Imaging ◽  
Receiver Operating Curve ◽  
Imaging Biomarker ◽  
Poor Clinical Outcome ◽  
Similar Time ◽  
Poor Outcome ◽  
Malignant Infarction

Background Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction. Aims We hypothesized that early-elevated lesion water uptake indicates accelerated “tissue clock” desynchronized with “time clock” and therefore predicts poor clinical outcome despite successful recanalization. Methods Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0–4 and mRS 5–6. Results Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0–4 was lower compared to patients with mRS 5–6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72). Conclusions Quantitative NWU may serve as an indicator of “tissue clock” and pronounced early brain edema with elevated NWU might suggest a desynchronized “tissue clock” with real “time clock” and therefore predict futile recanalization with poor clinical outcome.

Prediction of adverse outcomes by blood glucose level after endovascular therapy for acute ischemic stroke

2011 ◽  
Vol 114 (6) ◽  
pp. 1785-1799 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Paresh Dandona ◽  
Yuval Karmon ◽  
Albert J. Yoo ◽  
Junaid S. Kalia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Acute Ischemic Stroke ◽  
Glucose Level ◽  
Endovascular Therapy ◽  
Univariate Analysis ◽  
Diabetic Patients ◽  
Nihss Score ◽  
Poor Outcome

Object The authors evaluated the prognostic significance of blood glucose level at admission (BGA) and change in blood glucose at 48 hours from the baseline value (CG48) in nondiabetic and diabetic patients before and after endovascular therapy for acute ischemic stroke (AIS). Methods The BGA and CG48 data were analyzed in 614 patients with AIS who received endovascular therapy at 7 US centers between 2006 and 2009. Data reviewed included demographics, stroke risk factors, diabetic status, National Institutes of Health Stroke Scale (NIHSS) score at presentation, recanalization grade, intracranial hemorrhage (ICH) rate, and 90-day outcomes (mortality rate and modified Rankin Scale score of 3–6 [defined as poor outcome]). Variables with p values < 0.2 in univariate analysis were included in a binary logistic regression model for independent predictors of 90-day outcomes. Results The mean patient age was 67.3 years, the median NIHSS score was 16, and 27% of patients had diabetes. In nondiabetic patients, BGA ≥ 116 mg/dl (≥ 6.4 mmol/L) and failure of glucose level to drop > 30 mg/dl (> 1.7 mmol/L) from the admission value were both significant predictors of 90-day poor outcome and death (p < 0.001). In patients with diabetes, BGA ≥ 116 mg/dl (≥ 6.4 mmol/L) was an independent predictor of poor outcome (p = 0.001). The CG48 was not a predictor of outcome in diabetic patients. A simplified 6-point scale including BGA, Thrombolysis in Myocardial Infarction (TIMI) Grade 2–3 Reperfusion, Age, presentation NIHSS score, CG48, and symptomatic ICH (BRANCH) corresponded with poor outcomes at 90 days; the area under the curve value was > 0.79. Conclusions Failure of blood glucose values to decrease in the first 48 hours after AIS intervention correlated with poor 90-day outcomes in nondiabetic patients. The BRANCH scale shows promise as a simple prognostication tool after endovascular therapy for AIS, and it merits prospective validation.

scholarly journals Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 482-490
Author(s):  
Fabian Flottmann ◽  
Caspar Brekenfeld ◽  
Gabriel Broocks ◽  
Hannes Leischner ◽  
Rosalie McDonough ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cerebral Infarction ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Functional Independence ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
Vessel Occlusion

Background and Purpose: Endovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. Often, more than one retrieval attempt is needed to achieve reperfusion. We aimed to quantify the influence of endovascular therapy on clinical outcome depending on the number of retrievals needed for successful reperfusion in a large multi-center cohort. Methods: For this observational cohort study, 2611 patients from the prospective German Stroke Registry included between June 2015 and April 2018 were analyzed. Patients who received endovascular therapy for acute anterior circulation stroke with known admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score, final Thrombolysis in Cerebral Infarction score, and number of retrievals were included. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. The primary outcome was defined as functional independence (modified Rankin Scale score of 0–2) at day 90. Multivariate mixed-effects models were used to adjust for cluster effects of the participating centers and confounders. Results: The inclusion criteria were met by 1225 patients. The odds of good clinical outcome decreased with every retrieval attempt required for successful reperfusion: the first retrieval had the highest odds of good clinical outcome (adjusted odds ratio, 6.45 [95% CI, 4.0–10.4]), followed by the second attempt (adjusted odds ratio, 4.56 [95% CI, 2.7–7.7]), and finally the third (adjusted odds ratio, 3.16 [95% CI, 1.8–5.6]). Conclusions: Successful reperfusion within the first 3 retrieval attempts is associated with improved clinical outcome compared with patients without reperfusion. We conclude that at least 3 retrieval attempts should be performed in endovascular therapy of anterior circulation strokes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03356392.

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