Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 29,372 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
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.
© 2020 S. Karger AG, Basel
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.
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Zang N. · Lin Z. · Huang K. · Pan Y. · Wu Y. · Wu Y. · Wang S. · Wang D. · Ji Z. · Pan S.
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