High serum total cholesterol associated with good outcome in endovascular thrombectomy for acute large artery occlusion

Ha, Sang Hee; Ryu, Jae-Chan; Bae, Jae‐Han; Koo, Sujin; Kwon, Boseong; Song, Yunsun; Lee, Deok Hee; Chang, Joon-Hyuk; Kang, Dong‐Wha; Kwon, Sun U.; Kim, Jong Seung; Kim, Bum Joon

doi:10.1007/s10072-022-06269-4

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…This study demonstrated that a high LDL-C concentration early in the course of anterior circulation LVO is independently associated with favorable clinical outcomes (modified Rankin scale ≤2) at 3 months. Similarly, Ha et al [ 19 ] demonstrated that high LDL-C was associated with good functional outcomes at 90 days after thrombectomy. However, both studies did not assess the linkage between LDL-C and post-thrombectomy PH.…”

Section: Discussionmentioning

confidence: 93%

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Ahn¹,

Roth²,

Jo³

et al. 2023

Neurointervention

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Purpose: Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is to investigate the association between LDL-C and delayed parenchymal hematoma (PH) that was not seen on immediate post-thrombectomy dual-energy computed tomography (DECT).Materials and Methods: A retrospective analysis was conducted on all patients with anterior circulation large vessel occlusion who underwent thrombectomy at a comprehensive stroke center from 2018–2021. Per institutional protocol, all patients received DECT immediately post-thrombectomy and magnetic resonance imaging or CT at 24 hours. The presence of immediate hemorrhage was assessed by DECT, while delayed PH was assessed by 24-hour imaging. Multivariable analysis was performed to identify predictors of delayed PH. Patients with hemorrhage on immediate post-thrombectomy DECT were excluded to select only those with delayed PH.Results: Of 159 patients without hemorrhage on immediate post-thrombectomy DECT, 18 (11%) developed delayed PH on 24-hour imaging. In multivariable analysis, LDL-C (odds ratio [OR], 0.76; P=0.038; 95% confidence interval [CI], 0.59–0.99; per 10 mg/dL increase) independently predicted delayed PH. High-density lipoprotein cholesterol, triglyceride, and statin use were not associated. After adjusting for potential confounders, LDL-C ≤50 mg/dL was associated with an increased risk of delayed PH (OR, 5.38; P=0.004; 95% CI, 1.70–17.04), while LDL-C >100 mg/dL was protective (OR, 0.26; P=0.041; 95% CI, 0.07–0.96).Conclusion: LDL-C ≤50 mg/dL independently predicted delayed PH following thrombectomy and LDL-C >100 mg/dL was protective, irrespective of statin. Thus, patients with low LDL-C levels may warrant vigilant monitoring and necessary interventions, such as blood pressure control or anticoagulation management, following thrombectomy even in the absence of hemorrhage on immediate post-thrombectomy DECT.

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Section: Discussionmentioning

confidence: 93%

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Ahn¹,

Roth²,

Jo³

et al. 2023

Neurointervention

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“…Although the concept of "the lower the cholesterol, the better the outcome" stands as a well-known slogan for lipid-lowering therapy in patients with ischemic stroke 25 , Several studies have shown that a higher cholesterol level is associated with a better stroke outcome [26][27][28][29] . A significant association between elevated admission cholesterol at ischemic stroke onset and improved short-term functional outcome 30 or 10-year survival 31 was found in earlier studies.…”

Section: Discussionmentioning

confidence: 99%

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Niu,

Wang,

Yang

et al. 2024

Preprint

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BackgroundAggressive lipid-lowering therapy is recommended for patients with ischemic stroke; however, lipid paradox has been reported in several clinical studies. The mechanism of lipid paradox remains uncertain, and nutrition maybe one explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.Materials and MethodsA total of 5257 patients with ischemic stroke were recruited for analysis. The Controlling Nutritional Status (CONUT) score was utilized to investigate the risk of malnutrition. Individuals were classified into 4 groups based on their CONUT score. Poor outcomes and all-cause mortality were compared among patients with varied nutritional status and RC levels.ResultsPatients with moderate-severe malnutrition had the highest incidences of in-hospital complications, including pulmonary infection, renal dysfunction, and hemorrhagic transformation, and the highest rates of poor outcomes (61.3%,P<0.001) and all-cause mortality (32.8%,P< 0.001) during the 3-month follow-up period. Baseline higher RC level was an independent protective factor of adverse clinical outcomes for patients with any degree of malnutrition, which was not observed in patients without malnutrition. In addition, compared with the moderate-severe malnourished with RC <0.471 mmol/L, the adjusted ORs for poor outcomes and all-cause mortality were 0.805 (0.450–1.438) and 0.898 (0.502-1.607) for participants with 0.471-0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633-0.868 mmol/L, and 0.160 (0.037–0.689) and 0.202 (0.042-0.967) for ≥ 0.869 mmol/L, prospectively.ConclusionLipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients with ischemic stroke and good nutritional status. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial than aggressive lipid control.

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Dyslipidemia Treatment and Cerebrovascular Disease: Evidence Regarding the Mechanism of Stroke

Ha,

Kim

2024

J Lipid Atheroscler

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High serum total cholesterol associated with good outcome in endovascular thrombectomy for acute large artery occlusion

Cited by 5 publications

References 21 publications

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Dyslipidemia Treatment and Cerebrovascular Disease: Evidence Regarding the Mechanism of Stroke

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