Deans' stroke musings: Correlation between neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and adverse prognosis in patients who achieve complete recanalization after thrombectomy for acute large vessel occlusion stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, June 10, 2025

Correlation between neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and adverse prognosis in patients who achieve complete recanalization after thrombectomy for acute large vessel occlusion stroke

USELESS! Correlations give us NOTHING ON HOW TO RECOVER FROM THIS! You're fired!

Correlation between neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and adverse prognosis in patients who achieve complete recanalization after thrombectomy for acute large vessel occlusion stroke

Shunchao Ci¹

Di Li²

Feng Wang³

Ke Li³

Lin Yin¹^*

¹Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, China
²Department of Neurological Intervention and Neurological Intensive Care, Central Hospital of Dalian University of Technology, Dalian, China
³Department of Interventional Therapy, The First Hospital of Dalian Medical University, Dalian, China

Background: The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has emerged as a novel inflammatory marker with prognostic significance. This study aims to explore the association between NHR and adverse prognosis in patients with acute large vessel occlusion (LVO) stroke who achieved complete recanalization after mechanical thrombectomy (MT).

Methods: This retrospective study analyzed acute ischemic stroke (AIS) patients with LVO who underwent MT at three stroke centers in Dalian, China, between January 2016 and November 2023. Complete recanalization was defined as achieving a modified Thrombolysis in Cerebral Infarction (mTICI) grade 3. Blood parameters were assessed within 24 h after MT. We compared intergroup differences based on NHR tertiles and employed the multivariate logistic regression analysis to assess the relationship between NHR and adverse outcomes.

Results: This study included 348 AIS patients with LVO, of whom 215 (61.8%) had adverse clinical outcomes at 90 days. The multivariate logistic regression analysis revealed a significant association between an elevated NHR and 90-day adverse outcomes (OR 2.311, 95% CI 1.248–4.278, p = 0.008). A restricted cubic spline curve demonstrated a linear dose–response relationship between NHR and adverse outcomes, with a p-value of 0.348 for non-linearity.

Conclusion: Our findings revealed that an elevated NHR could increase the risk of adverse prognosis following complete recanalization after MT in acute LVO stroke patients, which indicated that NHR could serve as a potential inflammatory marker for identifying high risk patients.

Introduction

Mechanical thrombectomy (MT) has been established as an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) (1). Successful recanalization is typically defined as achieving modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3 (2). Previous studies have demonstrated that successful recanalization can be achieved in over 83% of patients after MT (3, 4). Despite successful recanalization, nearly half of the patients still exhibit unfavorable clinical outcomes at 90 days, a phenomenon termed futile recanalization (5–7). Current studies on futile recanalization primarily focus on patients who achieve successful recanalization (mTICI 2b-3) after MT; however, the understanding of potential factors associated with poor outcomes in patients who achieve complete recanalization (mTICI 3) remains limited. A systematic review and meta-analysis indicated that mTICI 3 is associated with better outcomes and safety compared to mTICI 2b, and the recanalization grade represents the most important modifiable predictor of patient prognosis (8). VanHorn et al. found that patients with complete recanalization still had a high proportion of adverse outcomes (9). Therefore, actively exploring the factors associated with futile recanalization in patients with mTICI grade 3 may help optimize patient management and improve clinical outcomes.

The inflammatory immune response plays a crucial role in the pathophysiology, treatment outcomes, and prognosis of ischemic stroke (10). Among leukocytes, neutrophils are the first immune cells to increase in circulation shortly after the onset of ischemic stroke (11). Neutrophils in the blood infiltrate ischemic or infarcted tissue through the compromised blood–brain barrier (BBB) and release inflammatory mediators, thereby increasing the risk of BBB disruption, reperfusion injury, hemorrhagic transformation, and malignant brain edema (12). High-density lipoprotein cholesterol (HDL-C) regulates macrophages and adipocytes via cholesterol transporters, exerting anti-inflammatory (13) and anti-atherosclerosis effects (14). As a potential inflammatory marker, the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has demonstrated certain prognostic value. This blood indicator is inexpensive and readily available. Huang et al. found that an elevated NHR is a potential predictor of long-term mortality and recurrence rates in elderly patients with acute myocardial infarction (15). A previous study indicated that NHR may be associated with an increased risk of adverse short-term outcomes following intravenous thrombolysis in AIS patients (16). However, its correlation with futile recanalization at mTICI3 remains unclear. This study aimed to investigate the relationship between NHR and adverse prognosis in LVO patients who achieved complete recanalization after MT.