Abstract
Objectives
Treatment of ischemic stroke with endovascular thrombectomy (EVT) leads to improved
outcomes compared to IV tPA. The neutrophil-lymphocyte ratio (NLR), a marker of inflammation,
has been proposed to predict outcomes in ischemic stroke patients and may be used
to identify patients at risk for poor outcomes after EVT.
Materials and Methods
This was a retrospective study of adult ischemic stroke patients undergoing EVT between
1/1/2018 and 12/31/2020. Outcomes were successful reperfusion (TICI score ≥2B), favorable
discharge NIHSS (≤4), favorable discharge and 3-month mRS (≤2), and symptomatic intracranial
hemorrhage (sICH). The primary exposure was NLR, measured pre- and post-EVT. Other
variables collected included demographics and timing of stroke onset, arrival, groin
puncture, tPA, and recanalization.
Results
A total of 592 patients were included. The most common vessel involved was the middle
cerebral artery (73%). Lower admission NLR was associated with favorable discharge
NIHSS and favorable discharge and 3-month mRS (all P < 0.01). NLRs measured after EVT were associated with all the primary outcomes. Improvements
in NLR after EVT were associated with favorable discharge (P = 0.02) and 3-month mRS (P = 0.02) and lower incidence of sICH (P = 0.01).
Conclusions
Because of the long-term functional deficits that can persist after ischemic stroke,
it is vital to identify patients with higher probability for these outcomes. The results
from this study showed that favorable NLR measures, as well as favorable trends in
NLR over time, are associated with improved outcomes, indicating that NLR is a useful
marker to identify patients at risk for poor functional outcomes.
Key Words
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References
- Heart Disease and stroke statistics—2017 update: a report from the american heart association.Circulation. 2017; 135: e146-e603https://doi.org/10.1161/CIR.0000000000000485
- Endovascular thrombectomy for acute ischemic stroke: a meta-analysis.JAMA. 2015; 314: 1832-1843https://doi.org/10.1001/jama.2015.13767
- Endovascular thrombectomy in acute ischemic stroke.Circ Cardiovasc Interv. 2018; 11e005362https://doi.org/10.1161/CIRCINTERVENTIONS.117.005362
- A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke.Int J Stroke. 2015; 10: 1168-1178https://doi.org/10.1111/ijs.12618
- Endovascular thrombectomy for acute ischemic stroke.Curr Cardiol Rep. 2019; 21: 112https://doi.org/10.1007/s11886-019-1217-6
- Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis.JAMA. 2016; 316: 1279-1289https://doi.org/10.1001/jama.2016.13647
- Blood pressure variability and neurologic outcome after endovascular thrombectomy.Stroke. 2020; 51: 511-518https://doi.org/10.1161/STROKEAHA.119.027549
- Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke.Eur J Neurol. 2019; 26: 1019-1027https://doi.org/10.1111/ene.13951
- Blood pressure trajectory groups and outcome after endovascular thrombectomy: a multicenter study.Stroke. 2022; 53: 1216-1225https://doi.org/10.1161/STROKEAHA.121.034408
- Post-stroke inflammation—target or tool for therapy?.Acta Neuropathol. 2019; 137 (Berl): 693-714https://doi.org/10.1007/s00401-018-1930-z
- Long-term T cell responses in the brain after an ischemic stroke.Discov Med. 2017; 24: 323-333
- The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer.Crit Rev Oncol Hematol. 2013; 88: 218-230https://doi.org/10.1016/j.critrevonc.2013.03.010
- Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population.Int Arch Med. 2012; 5: 2https://doi.org/10.1186/1755-7682-5-2
- What is the normal value of the neutrophil-to-lymphocyte ratio?.BMC Res Notes. 2017; 10: 12https://doi.org/10.1186/s13104-016-2335-5
- The relation between atherosclerosis and the neutrophil-lymphocyte ratio.Clin Appl Thromb Off J Int Acad Clin Appl Thromb. 2016; 22: 405-411https://doi.org/10.1177/1076029615569568
- Neutrophil lymphocyte ratio as a predictor of stroke.J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2013; 22: 1169-1174https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.01.011
- Follow-up neutrophil-lymphocyte ratio after stroke thrombectomy is an independent biomarker of clinical outcome.J NeuroInterventional Surg. 2021; 13: 609-613https://doi.org/10.1136/neurintsurg-2020-016342
- Clinical significance of baseline neutrophil-to-lymphocyte ratio in patients with ischemic stroke or hemorrhagic stroke: an updated meta-analysis.Front Neurol. 2019; 10: 1032https://doi.org/10.3389/fneur.2019.01032
- Leukocytes, collateral circulation, and reperfusion in ischemic stroke patients treated with mechanical thrombectomy.Stroke. 2019; 50: 3456-3464https://doi.org/10.1161/STROKEAHA.119.026743
- The effects of neutrophil to lymphocyte and platelet to lymphocyte ratios on prognosis in patients undergoing mechanical thrombectomy for acute ischemic stroke.Ann Ital Chir. 2018; 89: 367-373
- Neutrophil-lymphocyte ratio predicts functional and safety outcomes after endovascular treatment for acute ischemic stroke.Cerebrovasc Dis. 2018; 45 (Basel Switz): 221-227https://doi.org/10.1159/000489401
Article info
Publication history
Published online: October 22, 2022
Accepted:
October 6,
2022
Received in revised form:
October 4,
2022
Received:
July 5,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106843
Copyright
© 2022 Elsevier Inc. All rights reserved.