Inflammatory Biomarkers and Intracranial Hemorrhage after Endovascular Thrombectomy

Abstract

Background: Intracranial hemorrhage after endovascular thrombectomy is associated with poorer prognosis compared with those who do not develop the complication. Our study aims to determine predictors of post-EVT hemorrhage – more specifically, inflammatory biomarkers present in baseline serology. Methods: We performed a retrospective review of consecutive patients treated with EVT for acute large vessel ischemic stroke. The primary outcome of the study is the presence of ICH on the post-EVT scan. We used four definitions: the SITS-MOST criteria, the NINDS criteria, asymptomatic hemorrhage, and overall hemorrhage. We identified nonredundant predictors of outcome using backward elimination based on Akaike Information Criteria. We then assessed prediction accuracy using area under the receiver operating curve. Then we implemented variable importance ranking from logistic regression models using the drop in Naegelkerke R2 with the exclusion of each predictor. Results: Our study demonstrates a 6.3% SITS (16/252) and 10.0% NINDS (25/252) sICH rate, as well as a 19.4% asymptomatic (49/252) and 29.4% (74/252) overall hemorrhage rate. Serologic markers that demonstrated association with post-EVT hemorrhage were: low lymphocyte count (SITS), high neutrophil count (NINDS, overall hemorrhage), low platelet to lymphocyte ratio (NINDS), and low total WBC (NINDS, asymptomatic hemorrhage). Conclusion: Higher neutrophil counts, low WBC counts, low lymphocyte counts, and low platelet to lymphoycyte ratio were baseline serology biomarkers that were associated with post-EVT hemorrhage. Our findings, particularly the association of diabetes mellitus and high neutrophil, support experimental data on the role of thromboinflammation in hemorrhagic transformation of large vessel occlusions.

Impact of lipid profiles on parenchymal hemorrhage and early outcome after mechanical thrombectomy

“…20,21 In previous studies, the HT rate after MT ranged from 29.4% to 42.6% and the sICH rate ranged from 6.3% to 12.4%. [22][23][24][25] In our study, the HT rate was 41.9% and the sICH rate was 10.3%, in line with the results of previous studies. An observational study reported a PH rate of 25.7%, 26 which is close to our rate of 26.5%.…”

“…In previous studies, the HT rate after MT ranged from 29.4% to 42.6% and the sICH rate ranged from 6.3% to 12.4%. 22 , 23 , 24 , 25 In our study, the HT rate was 41.9% and the sICH rate was 10.3%, in line with the results of previous studies. An observational study reported a PH rate of 25.7%, 26 which is close to our rate of 26.5%.…”

Prognostic Role of the Platelet-Lymphocyte Ratio in Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy: A Meta-Analysis

“…However, the systematic review provided unclear results; although a higher PLR was observed in patients with sICH by both Topcuoglu et al and Inanc & Inana, this was only significant in the former study. 18 , 21 Additionally, Diestro et al 32 reported that admission PLR was not significantly associated with sICH in adjusted analyses.…”

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

“…Higher levels of CRP also affected the sICH incidence [46][47][48][49]. An association of some serological markers with post-EVT haemorrhage has also been demonstrated, with, among these, low platelets and white blood cells, along with high neutrophil counts, being risk factors of HT [50].…”

“…Conflicting data exists on the association of hyperlipidemia and platelet-to-lymphocyte ratio (PLR) with HT. Both high and low values of these parameters have been indicated as risk factors for haemorrhagic AIS transformation by different authors [27,29,33,50]. The exact mechanisms of how biochemical and serological parameters influence post-EVT HT occurrence is not well understood.…”