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

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Abstract

Background

The effect of cholesterol on the functional outcome after endovascular thrombectomy (EVT) is still controversial. This study aimed to investigate whether the lipid profile is associated with the EVT prognosis.

Methods

We retrospectively analyzed patients with emergent large vessel occlusion who underwent EVT. The blood lipid levels were measured in the fasting state, 1 day after admission. We divided patients into terciles of serum total cholesterol (TC) levels and compared the clinical characteristics among the groups. The factors associated with a good outcome at 3 months (modified Rankin scale 0–2) were investigated, considering the stroke mechanism and recanalization status.

Results

Among 274 patients, good outcomes were observed in 108 (39.4%) patients. Low initial severity (odds ratio (OR), 0.91, 95% confidence interval (CI), 0.858–0.954; p < 0.001) and high TC level (1.35, 1.034–1.758; p = 0.041) were associated with good outcomes. In patients with cardioembolism, young age (0.95, 0.915–0.991; p = 0.021), low initial severity (0.92, 0.857–0.988; p = 0.024), and high TC level (1.60, 1.019–2.499; p = 0.036) were associated with good outcomes. The lipid profile was not associated with a functional outcome in those with large artery atherosclerosis. In patients with complete recanalization, young age (0.97, 0.941–0.994; p = 0.016), low initial severity (0.91, 0.864–0.961; p = 0.001), absence of diabetes (0.45, 0.218–0.947; p = 0.035) or any hemorrhage (0.33, 0.142–0.760; p = 0.009), and high TC level (1.40, 1.031–1.879; p = 0.031) were associated with good outcomes.

Conclusions

A high TC level was associated with favorable outcomes after EVT, especially in patients with cardioembolism and complete recanalization.

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References

  1. Tong X, Li S, Liu W, Ren Z, Liu R, Jia B, Zhang X, Huo X, Luo G, Ma G, Wang A, Wang Y, Wang Y, Miao Z, Mo D, group A-As, (2021) Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study. BMC Neurol 21:377. https://doi.org/10.1186/s12883-021-02386-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Zang N, Lin Z, Huang K, Pan Y, Wu Y, Wu Y, Wang S, Wang D, Ji Z, Pan S (2020) Biomarkers of unfavorable outcome in acute ischemic stroke patients with successful recanalization by endovascular thrombectomy. Cerebrovasc Dis 49:583–592. https://doi.org/10.1159/000510804

    Article  CAS  PubMed  Google Scholar 

  3. Cagnazzo F, Derraz I, Dargazanli C, Lefevre PH, Gascou G, Riquelme C, Bonafe A, Costalat V (2020) Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS </=6: a meta-analysis. J Neurointerv Surg 12:350–355. https://doi.org/10.1136/neurintsurg-2019-015237

    Article  PubMed  Google Scholar 

  4. Pikija S, Sztriha LK, Killer-Oberpfalzer M, Weymayr F, Hecker C, Ramesmayer C, Hauer L, Sellner J (2019) Contribution of serum lipid profiles to outcome after endovascular thrombectomy for anterior circulation ischemic stroke. Mol Neurobiol 56:4582–4588. https://doi.org/10.1007/s12035-018-1391-3

    Article  CAS  PubMed  Google Scholar 

  5. Hussain G, Wang J, Rasul A, Anwar H, Imran A, Qasim M, Zafar S, Kamran SKS, Razzaq A, Aziz N, Ahmad W, Shabbir A, Iqbal J, Baig SM, Sun T (2019) Role of cholesterol and sphingolipids in brain development and neurological diseases. Lipids Health Dis 18:26. https://doi.org/10.1186/s12944-019-0965-z

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yaghi S, Elkind MS (2015) Lipids and cerebrovascular disease: research and practice. Stroke 46:3322–3328. https://doi.org/10.1161/STROKEAHA.115.011164

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cui T, Wang C, Zhu Q, Wang A, Zhang X, Li S, Yang Y, Shang W, Peng R, Wu B (2021) Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent reperfusion therapy. BMC Neurol 21:360. https://doi.org/10.1186/s12883-021-02387-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lee D, Lee DH, Suh DC, Kim BJ, Kwon SU, Kwon HS, Lee JS, Kim JS (2020) Endovascular treatment in patients with cerebral artery occlusion of three different etiologies. J Stroke 22:234–244. https://doi.org/10.5853/jos.2019.02404

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim BJ, Kim JS (2014) Ischemic stroke subtype classification: an Asian viewpoint. J Stroke 16:8–17. https://doi.org/10.5853/jos.2014.16.1.8

    Article  PubMed  PubMed Central  Google Scholar 

  10. Desai SM, Haussen DC, Aghaebrahim A, Al-Bayati AR, Santos R, Nogueira RG, Jovin TG, Jadhav AP (2018) Thrombectomy 24 hours after stroke: beyond DAWN. J Neurointerv Surg 10:1039–1042. https://doi.org/10.1136/neurintsurg-2018-013923

    Article  PubMed  Google Scholar 

  11. Gwak DS, Kwon JA, Shim DH, Kim YW, Hwang YH (2021) Perfusion and diffusion variables predict early neurological deterioration in minor stroke and large vessel occlusion. J Stroke 23:61–68. https://doi.org/10.5853/jos.2020.01466

    Article  PubMed  PubMed Central  Google Scholar 

  12. Xing PF, Yang PF, Li ZF, Zhang L, Shen HJ, Zhang YX, Zhang YW, Liu JM (2020) Comparison of aspiration versus stent retriever thrombectomy as the preferred strategy for patients with acute terminal internal carotid artery occlusion: a propensity score matching analysis. AJNR Am J Neuroradiol 41:469–476. https://doi.org/10.3174/ajnr.A6414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Dargazanli C, Fahed R, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, Saleme S, Costalat V, Bracard S, Desal H, Mazighi M, Consoli A, Piotin M, Lapergue B, Investigators AT (2018) Modified thrombolysis in cerebral infarction 2C/thrombolysis in cerebral infarction 3 reperfusion should be the aim of mechanical thrombectomy: insights from the ASTER Trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Stroke 49:1189–1196. https://doi.org/10.1161/STROKEAHA.118.020700

    Article  PubMed  Google Scholar 

  14. Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, Jickling GC (2021) Hemorrhagic transformation in ischemic stroke and the role of inflammation. Front Neurol 12:661955. https://doi.org/10.3389/fneur.2021.661955

    Article  PubMed  PubMed Central  Google Scholar 

  15. Piechowski-Jozwiak B, Bogousslavsky J (2004) Cholesterol as a risk factor for stroke: the fugitive? Stroke 35:1523–1524. https://doi.org/10.1161/01.STR.0000130460.09807.ec

    Article  PubMed  Google Scholar 

  16. Katiuscia Nardi M, PhD, Stefan Engelter M, PhD Daniel Strbian, MD, PhD Hakan Sarikaya, MD Marcel Arnold, MD, PhD Federica Casoni, MD, PhD, Gary A. Ford FCC, MD, PhD, Philippe Lyrer M, PhD Re´gis Bordet, MD, PhD Lauri Soinne, MD, PhD Henrik Gensicke, MD, PhD, Patrick Duriez M, PhD RalfW. Baumgartner, MD, Turgut Tatlisumak M, PhD, Didier Leys M, PhD On behalfofthe Lipid Profile in, Group TS (2012) Lipid profiles and outcome in patients treated by intravenous thrombolysis for cerebral ischemia. Neurology 79:1101–1108

    Article  Google Scholar 

  17. Cheng KH, Lin JR, Anderson CS, Lai WT, Lee TH, Group S (2018) Lipid paradox in statin-naive acute ischemic stroke but not hemorrhagic stroke. Front Neurol 9:541. https://doi.org/10.3389/fneur.2018.00541

    Article  Google Scholar 

  18. Mokin M, Masud MW, Dumont TM, Ahmad G, Kass-Hout T, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2014) Outcomes in patients with acute ischemic stroke from proximal intracranial vessel occlusion and NIHSS score below 8. J Neurointerv Surg 6:413–417. https://doi.org/10.1136/neurintsurg-2013-010720

    Article  PubMed  Google Scholar 

  19. Saito T, Itabashi R, Yazawa Y, Uchida K, Yamagami H, Sakai N, Morimoto T, Yoshimura S, Investigators RE-JR (2020) Clinical outcome of patients with large vessel occlusion and low national institutes of health stroke scale scores: subanalysis of the RESCUE-Japan Registry 2. Stroke 51:1458–1463. https://doi.org/10.1161/STROKEAHA.119.028562

    Article  PubMed  Google Scholar 

  20. Lai YT, Hsieh CL, Lee HP, Pan SL (2012) Are higher total serum cholesterol levels associated with better long-term motor function after ischemic stroke? Nutr Neurosci 15:239–243. https://doi.org/10.1179/1476830512Y.0000000016

    Article  CAS  PubMed  Google Scholar 

  21. Lee SH, Jang MU, Kim Y, Park SY, Kim C, Kim YJ, Sohn JH (2021) Impact of prior statin use on reperfusion rate and stroke outcomes in patients receiving endovascular treatment. J Clin Med 1010.3390/jcm10215147

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Authors and Affiliations

  1. Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea

    Sang Hee Ha, Jae-Chan Ryu, Jae-Han Bae, Jun Young Chang, Dong-Wha Kang, Sun U. Kwon, Jong S. Kim & Bum Joon Kim

  2. Graduate School of Converging Clinical and Public Health, Ewha Womans University, Seoul, South Korea

    Sujin Koo

  3. Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea

    Boseong Kwon, Yunsun Song & Deok Hee Lee

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  1. Sang Hee Ha
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Correspondence to Bum Joon Kim.

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Ethical approval

This study protocol was reviewed and approved by the Institutional Review Board of Asan medical center, approval number 2021–1781.

Informed consent

Written informed consent was not required because of the retrospective design by the ethic committee of Asan Medical Center.

Conflict of Interest

This research was supported by the Brain Convergence Research Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. 2020M3E5D2A01084576) and the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2020R1A2C2100077).

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Ha, S.H., Ryu, JC., Bae, JH. et al. High serum total cholesterol associated with good outcome in endovascular thrombectomy for acute large artery occlusion. Neurol Sci 43, 5985–5991 (2022). https://doi.org/10.1007/s10072-022-06269-4

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