Deans' stroke musings: Biomarkers of Unfavorable Outcome in Acute Ischemic Stroke Patients with Successful Recanalization by Endovascular Thrombectomy

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.

Monday, October 26, 2020

Biomarkers of Unfavorable Outcome in Acute Ischemic Stroke Patients with Successful Recanalization by Endovascular Thrombectomy

What appalling crapola. 'Biomarkers' NOT 'This is how to get to 100% recovery after successful recanalization.' THIS IS WHY ALMOST EVERYONE IN STROKE NEEDS TO BE FIRED, NO ONE IS EVEN TRYING TO SOLVE STROKE. You fucking idiots are predicting failure, what use is that to survivors? Have you ever actually talked to survivors? Rather than assuming survivors are OK with your failure to get them recovered?

Biomarkers of Unfavorable Outcome in Acute Ischemic Stroke Patients with Successful Recanalization by Endovascular Thrombectomy

Cerebrovasc Dis

https://doi.org/10.1159/000510804

Abstract

Background:

We aimed to identify plasma markers of unfavorable outcomes for patients with acute ischemic stroke (AIS) after recanalization by endovascular thrombectomy (EVT).

Methods:

From November 2017 to May 2019, we prospectively collected 61 AIS patients due to anterior large vessel occlusion who achieved recanalization by EVT. Plasma samples were obtained between 18 and 24 h after recanalization. Unfavorable outcomes included futile recanalization at 90 days and overall early complications within 7 days after EVT.

Results:

After adjustment for age and initial National Institute of Health Stroke Scale (NIHSS), matrix metalloproteinase-9 (MMP-9), tenascin-C, thioredoxin, ADAMTS13, and gelsolin were independently associated with both futile recanalization and overall early complications significantly (all p < 0.05), while C-reactive protein (CRP) was independently associated with overall early complications (p = 0.031) but at the limit of significance for futile recanalization (p = 0.051). The baseline clinical model (BCM) (including age and initial NIHSS) demonstrated discriminating ability to indicate futile recanalization (area under the curve [AUC] 0.807, 95% confidence interval [CI] 0.693–0.921) and overall early complications (AUC 0.749, 95% CI 0.611–0.887). BCM+MMP-9+thioredoxin enhanced discrimination (AUC 0.908, 95% CI 0.839–0.978, p = 0.043) and reclassification (net reclassification improvement [NRI] 67.2%, p < 0.001) to indicate futile recanalization. With respect to overall early complications, BCM+MMP-9+tenascin-C, BCM+MMP-9+CRP, BCM+MMP-9+ADAMTS13, BCM+tenascin-C+ADAMTS13, and BCM+CRP+ADAMTS13, all improved discrimination (AUC [95% CI]: 0.868 [0.766–0.970], 0.882 [0.773–0.990], 0.886 [0.788–0.984], 0.880 [0.783–0.977], and 0.863 [0.764–0.962], respectively, all p < 0.05 by the DeLong method) and reclassification (NRI 59.1%, 71.8%, 51.1%, 67.4%, and 38.3%, respectively, all p < 0.05).

Conclusions:

The increased levels of MMP-9, tenascin-C, CRP, thioredoxin, and decreased levels of ADAMTS13 and gelsolin were independent predictors of futile recanalization in AIS patients after recanalization by EVT.

Introduction

Endovascular thrombectomy (EVT) is a safe and effective treatment for acute ischemic stroke (AIS) caused by intracranial large vessel occlusion (LVO) in anterior circulation [1]. Despite successful recanalization via EVT, some patients develop early complications of AIS during the acute phase, including early neurological deterioration (END) [2], symptomatic hemorrhagic transformation (sHT) [3], brain herniation [4], and malignant brain edema (MBE) [5]. Besides, almost half of the patients remain functional dependence (modified Rankin Scale [mRS], 3–6) at 3 months after onset, which is thus called futile recanalization [6-8]. Prompt identification of patients at increased risks of unfavorable outcomes may help target patients who deserve close attention and timely treatments.

In previous studies, higher initial National Institute of Health Stroke Scale (NIHSS) score, older age, and longer time from onset to treatment were associated with poor AIS outcomes after EVT [6, 8, 9]. Aside from clinical parameters, blood biomarkers may also serve as a practical tool to represent the pathophysiology status before clinical deterioration. A number of studies have identified that various blood biomarkers, such as matrix metalloproteinase-9 (MMP-9) and C-reactive protein (CRP), are associated with functional outcomes of AIS [10, 11]. However, few studies have addressed the relationship of blood biomarkers with unfavorable outcomes in AIS patients who achieve successful recanalization via EVT. Therefore, we prospectively collected AIS patients with successful recanalization by EVT and investigated the prognostic plasma biomarkers that have potential association with the pathophysiology of AIS.