Relationship between the first pass effect and the platelet-lymphocyte ratio in acute ischemic stroke

Abstract

Purpose The aim of this study was to evaluate the relationship between platelet-lymphocyte ratio (PLR) and first pass effect (FPE) in patients with acute ischemic stroke (AIS). Our secondary goal was to investigate other laboratory, demographic or technical parameters that may be related to FPE and to search for independent predictors of FPE. Materials and methods Patients who underwent mechanical thrombectomy (MT) in our hospital between January 2017 and February 2020 were reviewed. Patients were divided into two groups: FPE and non-FPE. Demographic features, laboratory parameters, pretreatment imaging and clinical features, angiographic and clinical outcomes were recorded and compared between the two groups. Logistic regression analysis was performed to analyze the independent predictors and a predictive model was produced for demonstrating the possibility to achieve FPE. Results The study consisted of 83 patients (37 female, 46 male; mean age 62.69 ± 15.16) who were treated by MT. FPE was achieved in 32 patients (32/83, 38.6%). PLR was higher in the non-FPE group (195.35 ± 101.49) when compared to the FPE group (103.17 ± 37.06). A PLR value of <126.3 and female sex were found as independent predictors of FPE. Our predictive model estimated the chance of FPE as 77.9% in female patients who had PLR values lower than 126.3 while it was 77.1% when only using the PLR cutoff value. Conclusions High levels of PLR were associated with the failure of FPE. High values of PLR may be considered as a negative predictor for FPE achievement prior to MT in patients with AIS.

Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis

“…Lux et al did not provide groupwise data but reported that admission NLR was not significantly associated with SR. 55 One study also considered the first pass effect (FPE), where complete recanalization (mTICI 3) is achieved with a single pass and reported a lower NLR in the FPE group. 57…”

Clinical Results of the Advanced Neurovascular Access Catheter System Combined With a Stent Retriever in Acute Ischemic Stroke (SOLONDA)

“…Hard fibrin-rich clots are associated to lower recanalization rates due to reduced clot integration within the SR and a decreased deformability that impairs inclusion into the aspiration catheter. 18,19 The ANA device, which has the capability to expand up to index artery diameter, showed high rates of recanalization even when hard fibrin-rich clots were used in an in vitro model. 9 In our study, the high rates of reperfusion were associated to remarkable rates of good (mRS score 0-2: 57.2%) and excellent (mRS score 0-1: 45.2%) functional outcome.…”

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

“…Of these three studies, the differences between groups were significant only in Lee et al 33 ‘s work. Another study, reporting on the first pass effect (FPE), where complete recanalisation (mTICI 3) was achieved with a single pass, showed a significantly higher PLR in the non-FPE group, 35 further supporting an association of admission PLR with recanalisation outcomes.…”

“…Very few studies considered the association of dynamic PLR changes with outcomes, and thus, this could not be analysed. Finally, not all studies 12 , 13 , 17 , 22 , 34 , 35 excluded patients with active infection, malignancy, or chronic disease, which can influence lymphocyte count via systemic inflammation. 4 , 10 …”