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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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.
