Elevated mean platelet volume is associated with poor outcome after mechanical thrombectomy

Effect of routine inflammatory markers on clinical outcomes in acute basilar artery occlusion after endovascular thrombectomy: Results from ATTENTION registry

BACKGROUND

To investigate the relationship between clinical routine inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), white blood cell count (WBC), neutrophils, lymphocytes, and platelets with clinical outcomes in acute basilar artery occlusion (BAO) patients receiving endovascular treatment (EVT).

METHODS

We recruited 2134 acute BAO patients from 48 stroke centers across 22 Chinese provinces in the ATTENTION registry from 2017 to 2021. Blood samples were drawn at admission. An unfavorable functional outcome was defined using a modified Rankin Scale (mRS) of 4-6 at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage within 3 days.

RESULTS

A total of 1044 patients were included in the final study. After adjusting for confounding factors, the upper quartiles of WBC and NLR were related to 90-day unfavorable functional outcome (mRS = 4-6) compared with those in the lowest quartile (WBC: quartile 4, odds ratio (OR) = 1.85, 95% confidence interval (CI) = 1.22-2.80; NLR: quartile 4, OR = 2.02, 95% CI = 1.34-3.06). The higher quartiles of WBC and NLR were also related to the increased risk of mortality at 90 days. Restricted cubic spline regression analysis showed an incremental trend between NLR and 90-day unfavorable functional outcome (Pnonlinearity = 0.055). In subgroup analysis, a significant interaction was found between NLR and bridging therapy for predicting unfavorable functional outcome (P = 0.006).

CONCLUSION

Higher WBC and NLR on admission are significantly related to unfavorable functional outcome and mortality at 90 days in acute BAO patients receiving EVT. Significant interaction was found between increased NLR and bridging therapy on these outcome measures.

Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0-3) or unfavorable functional outcome (mRS 4-6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group.

Analysis of predictive factors of thrombosis in autogenous arteriovenous fistula

PURPOSE

To investigate the predictors of early diagnosis of thrombus of autogenous arteriovenous fistula (aAVF).

METHODS

The included patients were divided into the thrombus group with aAVF failure or thrombosis and the control group with good internal fistula function. The general data of the patients, including age, sex, diabetes mellitus, were collected. Platelets (PLT), platelet crit (P-LCR), platelet distribution width (PDW), mean platelet volume (MPV), homocysteine (HCY), and other biochemical data were collected. The predictors of thrombus of aAVF were obtained by the t test and logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was used to compare the area under the ROC curve (AUC) between the combined predictors and the original indicators. The optimal critical value was determined when the Youden index reached its maximum value, and the sensitivity, specificity, accuracy, diagnostic index, and so on were calculated. Finally, prediction was performed by substituting each value in individually.

RESULTS

PLT, PDW, P-LCR, MPV, and HCY showed significant differences between two groups (p < 0.05). Logistic regression analysis showed that, for PLT (OR = 1.014, 95% CI 1.006-1.022, p = 0.01), PDW (OR = 1.295, 95% CI 1.009-1.661, p = 0.042), P-LCR (OR = 1.230, 95% CI 1.089-1.389, p = 0.001), MPV (OR = 1.696, 95% CI 1.101-2.613, p = 0.017), and HCY (OR = 1.332, 95% CI 1.182-1.502, p = 0.01), the difference was significant; PLT, PDW, P-LCR, MPV, and HCY were positively correlated with thrombogenesis (p < 0.05). By logistic regression, a group of the five predictors of PLT, PDW, P-LCR, MPV, and HCY was obtained, and the combined predictors were 0.014*PLT + 0.258*PDW + 0.207*P-LCR + 0.528*MPV + 0.287*HCY. The area under the curve of the combined predictor was 0.933, the sensitivity was 92.4%, the specificity was 81.2%, the maximum diagnostic index was 0.736, the diagnostic cutoff point was 21.790, and the accuracy rate was 87%.

CONCLUSION

PLT, PDW, P-LCR, MPV, and HCY are predictors of thrombus of aAVF. They can better predict thrombus of aAVF, and the combination of these five indicators is better than a single indicator.

A new marker of short-term mortality and poor outcome in patients with acute ischemic stroke: Mean platelet volume-to-lymphocyte ratio

BACKGROUND

The mean platelet volume-to-lymphocyte ratio (MPVLR), as a novel marker of thrombosis and inflammation, has been demonstrated to be closely linked to poor cardiovascular disease prognosis. However, the correlation between MPVLR and acute ischemic stroke (AIS) remains unclear. This study, therefore, aimed to clarify the relationship between MPVLR and the short-term prognosis of AIS.

METHODS

A total of 315 patients with first-time AIS diagnoses were recruited and divided into 3 groups based on the tri-sectional quantiles for MPVLR on admission: group 1 (N = 105) with a MPVLR ≤ 4.93, group 2 (N = 105) with a MPVLR of 4.94 to 7.21, and group 3 (N = 105) with a MPVLR ≥ 7.22. All patients were followed-up for 3 months, and death within 3 months was defined as the endpoint. Baseline characteristics, stroke severity, and functional outcomes were evaluated.

RESULTS

The Spearman's correlation coefficient test showed that MPVLR was significantly positively correlated with the National Institutes of Health Stroke Scale score (R = 0.517, P < .001). Multivariate analysis revealed that MPVLR was an independent predictor of both short-term mortality (adjusted odds ratio [OR] 1.435, P < .001) and poor outcome (adjusted OR 1.589, P < .001). The receiver operating characteristic (ROC) curve analysis showed that the best cutoff value of MPVLR for short-term mortality and poor outcome were 6.69 (sensitivity: 86.4%, specificity: 68.6%) and 6.38 (sensitivity: 78.8%, specificity: 72.3%), respectively.

CONCLUSIONS

MPVLR on admission was positively associated with stroke severity. An elevated MPVLR is an independent predictor of short-term mortality and poor outcome after AIS.

Age and composition of the thrombus retrieved by mechanical thrombectomy from patients with acute ischemic stroke are associated with revascularization and clinical outcomes

INTRODUCTION

Understanding the composition of stroke thrombi retrieved by mechanical thrombectomy is essential to clarify the pathogenesis of stroke. However, it is difficult to evaluate thrombus composition precisely and objectively. Immunohistochemical staining was used to evaluate thrombus composition and age.

MATERIALS AND METHODS

Consecutive thrombi (n = 108) retrieved from patients who underwent mechanical thrombectomy for acute large-vessel ischemic stroke were retrospectively analyzed. Lytic features of granulocytes and CD163 were estimated as indicators of the age of the cardioembolic (CE) thrombus.

RESULTS

The stroke subtypes were as follows: CE, 74 cases; large artery atherosclerosis, 11; undetermined etiology, 12; and other determined etiology, 11. There were no statistical differences in thrombi composition according to stroke subtypes. The fibrin area was positively correlated with the red blood cell (RBC) and platelet areas. The following analysis was performed using CE only. Regarding age, the thrombus was judged as fresh in 30.0 % and older in 70.0 % based on the lytic features. The RBC areas of older thrombi were smaller than those of fresh thrombi. The puncture-to-reperfusion time of older thrombi was longer than that of fresh thrombi. Platelet-rich thrombi were associated with a greater number of maneuvers, a smaller prevalence of TICI 3, and unfavorable functional outcomes compared to platelet-poor thrombi. The number of CD163 positive cells in thrombi with anticoagulants was higher than in those without anticoagulants.

CONCLUSION

Thrombus composition correlated with revascularization and clinical outcomes. The composition of an acute ischemic thrombus may reflect the pathophysiology of stroke and influence treatment efficacy.

Serum microRNA-4297 is a sex-specific predictive biomarker of glioma grade and prognosis

Background

Gliomas account for nearly 80% of brain cancers, tending to occur more frequently in men with adverse outcomes. Emerging microRNAs have been positioned as promising predictors for glioma's histological grade and prognosis. However, there have been few studies concerning the sex-biased impacts on the clinical approach for the potential microRNA-4297 (miR-4297).

Methods

We utilized GSE139031micro-RNAs profiling to analyze serum miR-4297 expression in glioma. A total of 114 newly diagnosed glioma patients at the First Affiliated Hospital of Fujian Medical University from January 2017 to February 2021 were recruited and prospectively followed up. The association of miR-4297 levels with glioma grade and prognosis was investigated. Luciferase reporter gene assays and genotype analyses were carried out to explore the potential mechanism of sexually dimorphic miR-4297 in glioma.

Results

Serum miR-4297 levels were notably down-regulated in glioma. Besides, serum miR-4297 levels were positively associated with the high grades, which were exclusively present for females. The positive correlations of miR-4297 with O6-methylguanine-DNA methyltransferase (MGMT) protein and mean platelet volume were also observed in females. IDH-mutant females had decreased miR-4297. Median PFS time for females with miR-4297 ≥ 1.392 was distinctly shorter than those with miR-4297 <1.392 (12.3 months vs. 42.89 months, p = 0.0289). Based on multivariate logistic regression, miR-4297-based equation model was established as FHGRS. AU-ROC analysis revealed FHGRS exhibited a robust performance in predicting high-grade glioma in females (p < 0.001), whereas there was no such relationship in males. Furthermore, the MGMT-3'UTR variant rs7896488 in the specific binding region of miR-4297 was correlated with prognosis.

Conclusion

Our study uncovers sex-dependent characterization of serum miR-4297 in predicting glioma grade and the relapse risk for female patients, which underscores the clinical benefits of sex-specific analysis in non-coding RNA research.

Platelet distribution width: A significant predictor of poor outcome after mechanical thrombectomy

OBJECTIVES

Elevated platelet distribution width (PDW) is a recognized marker of platelet activity. Herein, we investigated the association between admission PDW values and clinical outcome at 3 months in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).

MATERIALS AND METHODS

We retrospectively collected consecutive patients diagnosed with AIS following MT from two stroke centers. PDW was measured on admission. Subjects were divided into two groups according to the clinical outcome using the modified Rankin Scale at 3 months. Multiple regression analyses and receiver operating characteristic (ROC) curves were performed to determine the associations between admission PDW values, clinical parameters, and functional outcome.

RESULTS

A total of 162 subjects were enrolled. Patients in the poor outcome group had a significantly higher percentage of PDW >16.0 fL compared with the good outcome group (57.3% vs. 26.9%, P < 0.001). After adjusting for a range of confounding factors, multiple regression analysis showed that PDW >16.0 fL was an independent predictor of poor outcome at 3 months (odds ratio 4.572, 95% confidence interval 1.896-11.026, P = 0.001). ROC curve analysis revealed that PDW >16.0 fL predicted poor outcome with 57.3% sensitivity and 73.1% specificity (the area under the ROC curve 0.637, 95% confidence interval 0.558-0.711, P = 0.004).

CONCLUSIONS

Elevated PDW is an independent predictor of poor functional outcome in patients with anterior circulation AIS undergoing MT at 3 months.

Nijeholt G, van Es A, van der Lugt A, Majoie C, Burke J, Roozenbeek B, Lingsma H, Dippel D. Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke: Systematic Review and External Validation

Supplemental Digital Content is available in the text.

Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice.

Mean Platelet Volume as a Potential Marker of Large Vessel Occlusion and Predictor of Outcome in Acute Ischemic Stroke Patients Treated with Reperfusion Therapy

(1) Background: An early diagnosis of a large vessel occlusion (LVO) is crucial in the management of the acute ischemic stroke (AIS). The laboratory predictors of LVO and a stroke outcome remain unknown. We have hypothesized that high MPV—a surrogate marker of the activated platelet—may be associated with LVO, and it may predict a worse AIS outcome. (2) Methods: This was a retrospective study of 361 patients with AIS who were treated with thrombolysis (tPA, 65.7%) and/or mechanical thrombectomy (MT, 34.3%) in a tertiary Stroke Center between 2011 and 2019. (3) Results: The mean MPV in the cohort was 9.86 ± 1.5 fL (1st–4th quartiles: <8.8, >10.80 fL). Patients in the 4th quartile compared to the 1st had a significantly (p < 0.01) more often incidence of an LVO related stroke (75% vs. 39%) and a severe stroke manifestation with a higher RACE score (5.2 ± 2.8 vs. 3.3 ± 2.4), NIHSS at baseline (mean ± SD, 14 ± 6.5 vs. 10.9 ± 5.2), and NIHSS at discharge (6.9 ± 7 vs. 3.9 ± 3.6). A multivariate analysis revealed that quartiles of MPV (OR 1.4; 95%CI 1.2–1.8) significantly predicted an LVO stroke, also after the adjustment for RACE < 5 (OR 1.4; 95%CI 1.08–1.89), but MPV quartiles did not predict a favorable stroke outcome (mRS ≤ 2) (OR 0.89; 95%CI 0.7–1.13). (4) Conclusion: Our data suggest that MPV is an independent predictor of LVO in patients with an acute ischemic stroke.

Association of inflammatory and platelet volume markers with clinical outcome in patients with anterior circulation ischaemic stroke after endovascular thrombectomy

Background: To determine the correlation of inflammatory and platelet volume indices with the severity of stroke and 3-month clinical outcomes in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT).Methods: A retrospective analysis was conducted for AIS patients who underwent EVT at our hospital from 2015 to 2019. Inflammatory factors, including white blood count, neutrophil count, lymphocyte count, neutrophil to lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT) and interleukin-6 (IL-6), and platelet volume indices, including platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and MPV/PC levels were assessed. Results were analyzed between patients with favorable and unfavorable outcomes at 3 months post-EVT.Results: A total of 257 AIS patients were included in the study. There were 86 (33.5%) patients with favorable functional outcomes at 3 months. Compared to patients with favorable outcomes, those with poor outcomes have lower lymphocyte count, higher neutrophil count and NLR levels. There were no differences in hs-CRP,PCT and IL-6 between the two groups. The correlation analysis showed that the increase in MPV, PDW, and MPV/PC was related to the high level of the NIHSS score at admission. Multivariate logistic regression analysis showed that higher NLR levels are an independent risk factor for unfavorable outcomes at 3 months (OR = 1.141; 95% CI 1.061 to 1.227, P = 0.000).Conclusions: MPV, PDW, and MPV/PC are associated with stroke severity. Higher NLR levels upon admission may predict unfavorable functional outcomes in patients with AIS after undergoing EVT.Abbreviations ACA: anterior cerebral artery; AIS: acute ischemic stroke; ASPECTS: alberta stroke program early CT score; BMI: body mass index; DBP: diastolic blood pressure; END: early neurological deterioration; EVT: endovascular thrombectomy; hs-CRP: high-sensitivity C-reactive protein; HT: hemorrhagic transformation; ICA: internal carotid artery; IL-6: interleukin-6; IS: ischemic progression; LAA: Large-Artery Atherosclerosis; MCA: middle cerebral artery; MPV: mean platelet volume; mTICI: modified thrombolysis in cerebral infarction; NIHSS: National Institute of Health stroke scale; NLR: neutrophil to lymphocyte ratio; OTP: onset-to-puncture; PC: platelet count; PCT: procalcitonin; PDW: platelet distribution width; SBP: systolic blood pressure; sICH: symptomatic intracerebral hemorrhageWBC: white blood cell.

Mean platelet volume and mechanical thrombectomy

BACKGROUND AND PURPOSE

Mean Platelet Volume (MPV) is a marker of platelet activity and it is an independent predictor for long-term outcome in stroke patients. The aim of this study was to evaluate the association between baseline MPV value and clinical outcome at 90-days in anterior circulation stroke and large vessel occlusion (LVO) patients submitted to mechanical thrombectomy (MT).

METHODS

We conducted a prospective observational cohort study in acute ischemic stroke (AIS) patients submitted to MT between January 2017 and May 2018. MPV was measured at admission. Patients were initially stratified into two groups according to the mean MPV level. We also compared groups that were stratified according to the MPV cut-off obtained by Peng F et al (10,4 fL) and performed analyses among MPV terciles.

RESULTS

A total of 129 patients were included. Mean level of MPV was 10,9 fL. Patients with embolic stroke of undetermined source (ESUS) had significantly higher rates of good outcome at 3 months compared with large-artery atherosclerotic disease and cardioembolism [(82,9%) vs (78,3%) vs (55,2%); p=0,009]. There were no statistically significant differences in the mean MPV value (p=0,222), successful recanalization (p=0,464) and mortality (p=0,343) when evaluated for all TOAST etiologies. There were no statistically significant differences between the two groups according to the MPV level (10,4 and 10,9 fL) or between the terciles (lowest tertile <10,3 fL, median 10,3 - 11,3 fL, highest >11,3fL) concerning functional outcome at 3 months (p=0,357; p=0,24 and p=0,558, respectively), successful recanalization (p=0,108; p=0,582 and p=0,899, respectively) or mortality at 3 months (p=0,465; p=0,061 and p=0,484, respectively).

CONCLUSION

Our study did not find an association between elevated MPV and worse outcome at 3 months in patients with acute anterior circulation stroke and LVO treated with MT. Since ischemic strokes have different pathophysiologic mechanisms, MPV may have distinct prognostic value according to each stroke etiology.

Mean platelet volume and its genetic variants relate to stroke severity and 1-year mortality

OBJECTIVE

To determine whether mean platelet volume (MPV) and selected single nucleotide polymorphisms (SNPs) that have been associated with MPV in genome-wide association studies relate to stroke severity, functional outcome on discharge, and 1-year mortality in patients with ischemic stroke, we retrospectively analyzed 577 patients with first-ever ischemic stroke.

METHODS

Genotyping of 3 SNPs (rs342293, rs1354034, rs7961894) was performed using a real-time PCR allelic discrimination assay. Multivariable regression was used to determine the association of MPV and MPV-associated SNPs with the NIH Stroke Scale (NIHSS) score on admission, modified Rankin Scale score on discharge, and data on 1-year mortality.

RESULTS

Rs7961894, but not rs342293 or rs1354034 SNP, was independently associated with an MPV in the highest quartile (MPV Q4). MPV Q4 was associated with significantly greater admission NIHSS (p = 0.006), poor discharge outcome (p = 0.034), and worse 1-year mortality (p = 0.033). After adjustment for pertinent covariates, MPV Q4 remained independently associated with a greater admission NIHSS score (p = 0.025). The T>C variant of rs7961894 SNP was an independent marker of a lower 1-year mortality (hazard ratio, 0.30; 95% confidence interval, 0.13-0.70; p = 0.006) in the studied population.

CONCLUSION

MPV is a marker of stroke severity and T>C variant of rs7961894 is independently associated with greater MPV in acute phase of ischemic stroke and relates to decreased 1-year mortality after stroke.

Mean platelet volume and coronary artery disease

PURPOSE OF REVIEW

To critically review the literature describing links between mean platelet volume (MPV) and cardiovascular disease (CVD). We will focus on coronary artery disease (CAD). The MPV is measured routinely as part of a routine blood count.

RECENT FINDINGS

There is accumulating evidence showing that the MPV may predict CVD, as well as outcomes in patients with CAD. There is also evidence linking MPV and comorbidities (e.g. diabetes mellitus and impaired glycaemic control) that are expected in patients with CAD. The effect on MPV of drugs commonly used to treat CAD has not been clarified, but there is some evidence that they may exert a beneficial effect on the MPV. More specifically, the MPV may predict the effect of antiplatelet drugs (e.g. clopidogrel). There is also evidence relating MPV to stroke, atrial fibrillation, coronary artery ectasia and periprocedural outcomes after percutaneous coronary intervention (PCI).

SUMMARY

Measuring the MPV may prove useful in CVD risk assessment in patients with established CAD or at risk of developing CAD. Overall, there is evidence pointing to the role of MPV as a contributor rather than simple marker of CVD.

Association Between Mean Platelet Volume and Hemorrhagic Transformation in Acute Ischemic Stroke Patients

BACKGROUND

Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke (AIS). Mean platelet volume (MPV) is a marker of platelet function. The relationship between MPV and HT remains unclear.

METHODS

From January 1st, 2012 to December 31st 2016, we consecutively enrolled AIS patients admitted to the Department of Neurology of West China Hospital. MPV was measured on admission. HT was diagnosed by brain imaging and classified into hemorrhagic infarct (HI) and parenchymal hematoma (PH). Moreover, subjects were divided into tertiles according to MPV levels. Confounders were identified by univariate analysis and multivariate logistic regression was performed to explore the association between MPV and HT as well as HT subtypes. Also, a generalized additive model was used to investigate whether a non-linear association existed between MPV and HT.

RESULTS

A total of 783 AIS patients were included. 63 patients (8.0%) developed HT: 34 (4.3%) HI and 29 (3.7%) PH. It was observed that MPV positively correlated with HT. After adjustment for confounders, patients in the highest MPV tertile had a significantly increased risk of HT compared to patients in the lowest tertile (odds ratio 2.3, 95% confidence interval 1.0-5.4, P=0.04). The risk of HT increased step-wise across MPV tertiles (P for trend=0.04). MPV tertiles significantly correlated with HI rather than PH. The generalized additive model demonstrated a nonlinear association between MPV and HT (P=0.02).

CONCLUSION

The risk of HT increased with increasing MPV level in a dose-dependent manner. Patients with elevated MPV levels were more likely to develop HI rather than PH.

MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours

OBJECTIVES

The MRI-DRAGON score includes clinical and MRI parameters and demonstrates a high specificity in predicting 3 month outcome in patients with acute ischemic stroke (AIS) treated with intravenous tissue plasminogen activator (IV tPA). The aim of this study was to adapt this score to mechanical thrombectomy (MT) in a large multicenter cohort.

METHODS

Consecutive cases of AIS treated by MT between January 2015 and December 2017 from three stroke centers were reviewed (n=1077). We derived the MT-DRAGON score by keeping all variables of the MRI-DRAGON score (age, initial National Institutes of Health Stroke Scale score, glucose level, pre-stroke modified Rankin Scale (mRS) score, diffusion weighted imaging-Alberta Stroke Program Early CT score ≤5) and considering the following variables: time to groin puncture instead of onset to IV tPA time and occlusion site. Unfavorable 3 month outcome was defined as a mRS score >2. Score performance was evaluated by c statistics and an external validation was performed.

RESULTS

Among 679 included patients (derivation and validation cohorts, n=431 and 248, respectively), an unfavorable outcome was similar between the derivation (51.5%) and validation (58.1%, P=0.7) cohorts, and was significantly associated with all MT-DRAGON parameters in the multivariable analysis. The c statistics for unfavorable outcome prediction was 0.83 (95%CI 0.79 to 0.88) in the derivation and 0.8 (95%CI 0.75 to 0.86) in the validation cohort. All patients (n=55) with an MT-DRAGONscore ≥11 had an unfavorable outcome and 60/63 (95%) patients with an MT-DRAGON score ≤2 points had a favorable outcome.

CONCLUSION

The MT-DRAGON score is a simple tool, combining admission clinical and radiological parameters that can reliably predict 3 month outcome after MT.

Benefit from mechanical thrombectomy in acute ischemic stroke with fast and slow progression

Objective

The rate of progression of the ischemic lesion is variable in patients with stroke. We tested the hypothesis that the tissue saving effect of mechanical thrombectomy (MT) is greater in fast progressors.

Methods

A single-center cohort of consecutive patients (n=242) with occlusions of the terminal internal carotid or M1 segment of the middle cerebral artery treated with MT (n=195) or best medical treatment (n=47), known time from onset, and full imaging (baseline CT perfusion and follow-up MRI) available was studied. The estimated infarct progression rate (eIPR) was calculated at baseline and patients were categorized as fast/slow progressors according to the median eIPR of 4.8 mL/hour. The primary outcome measure was the interaction between eIPR category and MT on infarct growth. The secondary outcomes assessed the effect of MT on final infarct volume and functional status in relation to the eIPR category. The safety outcomes were mortality and symptomatic intracranial hemorrhage.

Results

The eIPR category had a modifying effect (Pi=0.017) of MT on infarct growth that was significantly reduced with MT only in fast progressors (median (IQR) 3.8 mL (−11–55) vs 41 mL (11–107) with medical treatment; p=0.009, adjusted p=0.045). There was also a significant interaction on final infarct volume (Pi=0.005), with a greater reduction after MT in fast progressors. The functional status improved with MT both in fast and slow progressors, with no significant modifying effect of eIPR category (Pi=0.201). There were also no significant interactions on safety outcomes.

Conclusion

MT in stroke patients with large vessel occlusion limits infarct growth more significantly in fast progressors.

Association between platelet distribution width and poor outcome of acute ischemic stroke after intravenous thrombolysis

PURPOSE

The platelet distribution width (PDW) reflects the status of platelet activity and may be useful for early predictions of the clinical outcome of stroke patients. The purpose of the study was to determine the associations between PDW and clinical outcomes after intravenous thrombolysis in stroke patients.

PATIENTS AND METHODS

Acute ischemic stroke patients who received intravenous treatment with recombinant tissue-type plasminogen activator were selected for inclusion in the retrospective cohort of this study. The relations between PDW at admission and clinical outcomes were analyzed, including a poor outcome as assessed using the modified Rankin Scale at 3 months, early neurological improvement, and any hemorrhage. The effect of PDW at admission on a poor outcome at 3 months was analyzed using a multivariable logistic regression model with adjustment for potential confounders. The optimal PDW cutoff for predicting poor outcome at 3 months was determined by analyzing the receiver operating characteristics curve.

RESULTS

PDW was significantly higher for a good outcome than a poor outcome (p=0.005), with median (interquartile range) values of 16.2 (13.2-17.2) and 13.6 (12.5-15.9), respectively. PDW was also higher in patients with early neurological improvement than in patients without improvement (p=0.020) and did not differ between hemorrhage and nonhemorrhage patients. The association between PDW <16.05% and poor outcome remained in a multivariable logistic regression analysis, with an OR of 6.68 and a 95% CI of 1.69-26.49 (p=0.007).

CONCLUSION

Results suggest a novel hypothesis that a lower PDW may be related with a poor outcome at 3 months after intravenous thrombolysis in acute ischemic stroke patients.

Baseline platelet parameters for predicting early platelet response and clinical outcomes in patients with non-cardioembolic ischemic stroke treated with clopidogrel

Purpose

The present study investigated whether routine baseline platelet parameters(BPPs) detected before clopidogrel therapy in acute non-cardioembolic ischemic stroke(NCIS) could predict early platelet response and future clinical outcomes.

Results

The CYP2C19 polymorphisms constituted independent risk factors for LCR. The number of female patients, the incidence of diabetes mellitus (DM), the level of low-density lipoprotein(LDL) cholesterol, and the neutrophil-to-lymphocyte ratio(NLR) were significantly high in the clinical clopidogrel resistance (CCR) group. However, none of the BPPs had a significant association with laboratory clopidogrel resistance (LCR) or discriminated with the cut-off values regarding LCR or CCR. The patients were divided into two groups according to the average mean platelet volume(MPV) or platelet count(PC). We found that the HbA1c level, the number of female patients, and the CCR were higher in the groups with elevated MPV (≥ 10.6fL) and PC (≥ 235 × 10⁹/L); the LCR, the NIHSS score at discharge, and elevated MPV and PC were risk predictors for CCR.

Materials and Methods

This study included 196 patients with acute NCIS who underwent routine blood tests upon admission, were treated with clopidogrel, and were followed up for 6 months. Early platelet response was assessed and the CYP2C19 genetic variants were screened for. All participants were categorized into either laboratory clopidogrel resistance(LCR) or clinical clopidogrel resistance (CCR) groups.

Conclusions

Elevated baseline MPV and PC before clopidogrel therapy, as well as CYP2C19 gene variants, should be included in a risk algorithm for NCIS. Furthermore, other nongenetic clinical risk factors should be assessed for optimal prediction of the risk for thrombotic events because of individual variability in platelet response to clopidogrel.