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Cong Y, Xia X, Liao J, Zhang A, Zhang T, Cao X, Liu P, Ma F, Tang X, Chen J, Han Y, Chen Z, Li W, Zhu Y, Yao B, Wu M. Association of Systemic Inflammatory Response Index and Neutrophil-to-Lymphocyte Ratio on Unfavorable Functional Outcomes in Acute Ischemic Stroke Patients After Endovascular Therapy. World Neurosurg 2024:S1878-8750(24)01435-9. [PMID: 39151692 DOI: 10.1016/j.wneu.2024.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Inflammatory markers for the prognosis of acute ischemic stroke (AIS) with endovascular therapy remain unclear. The purpose of this study was to investigate the association between the systemic inflammatory response index (SIRI) and neutrophil-to-lymphocyte ratio (NLR) with unfavorable functional outcomes at 90-day in individuals of AIS who underwent endovascular therapy. METHODS A total of 128 AIS patients who had endovascular therapy were enrolled from the Nanjing Stroke Registry between September 2019 and November 2022. Peripheral venous blood was collected from patients within 24 h of admission for information on the following parameters: neutrophil count, lymphocyte count, and monocyte count. Then, the SIRI and NLR values were calculated and the association among SIRI, NLR, and modifled Rankin Scale scores 90 days after endovascular therapy was examined via univariate and multivariate logistic analyses. Receiver operating characteristic curves were utilized to determine the best threshold for SIRI and NLR in predicting negative neurological outcomes following endovascular treatment for patients with AIS. RESULTS A total of 128 participants were evaluated, among which 50% had unfavorable outcomes. Linear regression analysis showed that the best threshold for SIRI was >1.407 (odds ratio = 1.265; 95% confidence interval, 1.071-1.493; P = 0.006), and for NLR it was >5.347 (odds ratio = 1.088; 95% confidence interval, 1.007-1.175; P = 0.033). These results revealed NLR and SIRI as significant predictors of unfavorable outcomes at 90 days. The area under the curve for SIRI and NLR in predicting 90-day adverse outcomes was 0.643 and 0.609, respectively. CONCLUSIONS Higher SIRI and NLR levels at admission may lead to unfavorable outcomes at 90 days for AIS patients with endovascular therapy.
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Affiliation(s)
- Yujun Cong
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Rushan Hospital of Traditional Chinese Medicine, Weihai, China
| | - Xin Xia
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Rugao Boai hospital, Nantong, China
| | - Junqi Liao
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Aimei Zhang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Tianrui Zhang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaofeng Cao
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Peian Liu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Fei Ma
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaogang Tang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jingyi Chen
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yang Han
- Department of Neurology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Zhaoyao Chen
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenlei Li
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan Zhu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Beibei Yao
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
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Chen L, Gong C, Huang J, Chen Y, Sang H, Kong W, Guo M, Huang L, Chen B, Nguyen TN, Liu C. Chronic mitral regurgitation predicts acute heart failure and worse outcomes after endovascular treatment for large vessel occlusion stroke. J Neurointerv Surg 2024:jnis-2024-021871. [PMID: 39043583 DOI: 10.1136/jnis-2024-021871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Valvular diseases are widely recognized as important etiologies for large vessel occlusion stroke (LVO) but their impact on outcomes among patients with LVO receiving endovascular treatment (EVT) are less well delineated. METHODS This study was a post hoc exploratory analysis of the RESCUE-BT trial, DEVT trial and BASILAR prospective registry. Outcome measures included the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage, and post-stroke early acute heart failure (EAHF). Chronic significant mitral regurgitation (csMR) was defined as a long-existing mitral regurgitation (MR) with moderate-to-severe MR grade examined by the transthoracic echocardiography. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were obtained by logistic regression models. RESULTS Among 2011 patients in these three studies, 837 individuals receiving EVT with available information for valvular status were included in this study. In all categories of chronic valvular disorders, only csMR was related to very poor outcomes (mRS 5-6, aOR 2.76 (95% CI 1.59 to 4.78), P<0.001). CsMR (aOR 7.65 (95% CI 4.33 to 13.49), P<0.001) was an independent predictor of post-stroke EAHF. Mediation analysis showed that csMR increased EAHF instead of reocclusion events or venous thrombosis mediated its effects on functional outcome (49.50% (95% CI 24.83% to 90.00%)). Identical results of csMR on clinical outcomes and post-stroke EAHF were detected in novel cohorts constructed by propensity score matching and sensitivity analysis. CONCLUSION Our study demonstrated that csMR was a mediator of heart-brain interaction associated with poor outcomes of LVO after EVT by increasing the frequency of post-stroke EAHF. Replication of these findings in a larger cohort is warranted.
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Affiliation(s)
- Liyuan Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chen Gong
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
- Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Weilin Kong
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Meng Guo
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Liping Huang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Boyu Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
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Elfil M, Bahbah EI, Bayoumi A, Aladawi M, Eldokmak M, Salem MM, Aboutaleb PE, Villafuerte-Trisolini B, Al-Mufti F, Ortega-Gutierrez S, A Gonzalez-Castellon M. Repeated mechanical thrombectomy for recurrent large vessel occlusion: A systematic review and meta-analysis. Interv Neuroradiol 2022:15910199221134307. [PMID: 36285483 DOI: 10.1177/15910199221134307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) is the standard treatment for acute large vessel occlusion (LVO). Recurrent LVO can still occur in patients who already underwent MT for the first LVO. This study aimed to evaluate the efficacy of repeating MT for recurrent LVO. METHODS This meta-analysis of the available literature was conducted to summarize the current evidence regarding repeated MT outcomes in patients with recurrent LVO. All studies with ≥ 1 outcomes of interest were included. The Newcastle-Ottawa Scale (NOS) was used for risk of bias assessment. RESULTS Twenty studies, 10 observational (n = 21,251 patients) and 10 case reports (n = 10 patients), were included. 266 patients (62.78% females) with recurrent LVO were identified, with an overall prevalence of 1.6% and a mean age of 65.67 ± 16.23 years. Cardio-embolism was the most common mechanism in both times, with a median of 15 days between the first and second LVOs. Compared with pre-intervention, the first and second MTs significantly reduced the National Institute of Health Stroke Scale (NIHSS) score, (mean difference (MD) = -8.91) and (MD = -5.97) respectively, with a significant difference (p = 0.001). The rate of favorable outcome (modified Rankin scale (mRS) score 0-3) was 82.6% and 59.2% after the first and second MTs respectively, with a significant difference (p < 0.001). CONCLUSION In properly selected recurrent LVO patients, repeated MT is efficacious and safe. A prior MT procedure should not discourage aggressive treatment as many patients may achieve favorable outcomes.
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Affiliation(s)
- Mohamed Elfil
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Eshak I Bahbah
- 486471Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ahmed Bayoumi
- 12339McGovern Medical School, UT Houston, Houston, TX, USA
| | - Mohammad Aladawi
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Eldokmak
- Department of Neurology, 12298SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the 6572University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Hospital of the 6572University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | | | - Fawaz Al-Mufti
- Department of Neurosurgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Department of Neurology, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, 21782University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Neurosurgery, 21782University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, 21782University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Bralic M, Sosic M, Kovacic S, Vuletic V. Reperfusion therapy in a patient with early recurrence of ischemic stroke. Neurol Sci 2021; 43:673-676. [PMID: 34480242 DOI: 10.1007/s10072-021-05587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. Recurrent ischemic stroke (RIS) is associated with adverse neurological outcomes but the phenomenon of early RIS in the endovascular thrombectomy era has not been frequently discussed. We report a case addressing this issue. CASE PRESENTATION We present a patient who was successfully treated by mechanical thrombectomy (MT) for middle cerebral artery occlusion. Due to an early stroke recurrence, within 72 h after the first MT, he received systemic thrombolysis and repeated MT was performed with excellent clinical outcome. DISCUSSION We discuss the aspects of reperfusion therapy for patients experiencing early stroke recurrence. Consideration was given to stroke etiology and off-label use of thrombolytic therapy. Also, effectiveness of repeated MT for early re-occlusion of initially reanalyzed vessel was evaluated in order to allow more patients with RIS to benefit from reperfusion therapy.
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Affiliation(s)
- Marina Bralic
- Department of Neurology, Clinical Hospital Centre Rijeka, Kresimirova 42, 51 000, Rijeka, Croatia.
| | - Matija Sosic
- Department of Neurology, Clinical Hospital Centre Rijeka, Kresimirova 42, 51 000, Rijeka, Croatia
| | - Slavica Kovacic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Vladimira Vuletic
- Department of Neurology, Clinical Hospital Centre Rijeka, Kresimirova 42, 51 000, Rijeka, Croatia
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