- 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.
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