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Systemic Immune-Inflammation Response is Associated with Futile Recanalization After Endovascular Treatment

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Abstract

Background

Frequent incidence of futile recanalization decreases the benefit of endovascular treatment (EVT) in acute ischemic stroke. We hypothesized that the inflammation and immune response after ischemic are associated with futile recanalization. We aimed to investigate the correlation of admission systemic immune-inflammation index (SII) with futile recanalization post EVT.

Methods

Patients with successful recanalization (modified Thrombolysis in Cerebral Ischemia angiographic score 2b–3) and maintained artery recanalized after 24 h of EVT were chosen from a prospective nationwide registry study. Futile recanalization was defined as a poor functional outcome (modified Rankin Scale score 3–6) at 90 days, irrespective of a successful recanalization. At admission, SII was calculated as (platelet count × neutrophil count)/lymphocyte count/100. Logistic regression analysis helped to test the relationship of SII with futile recanalization.

Results

Among the 1,002 patients included, futile recanalization occurred in 508 (50.70%). No matter whether tested as quartiles or continuous variables, SII was significantly associated with futile recanalization (P < 0.05), and for every one standard deviation increase of SII, the risk of futile recanalization elevated by 22.3% (odds ratio 1.223, 95% confidence interval 1.053–1.444, P = 0.0093). Moreover, no significant interactions could be observed between SII or SII quartiles and age, baseline National Institutes of Health Stroke Scale scores, onset-to-recanalization time, and modified Thrombolysis in Cerebral Ischemia angiographic scores (all P for interaction > 0.05).

Conclusions

Early SII elevation was associated with an increased risk of futile recanalization among patients with EVT. Our results indicated that therapeutic drug targeting hyperreactive immune-inflammation response might be helpful for reducing the incidence of futile recanalization.

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Source of Support

Zhongrong Miao reports grants from the National Key Research and Development Program of China (2016 YFC1301500). Anxin Wang reports grants from National Key Research and Development Program of China (2022YFC3600600 and 2022YFC3600603), Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXZ009), and Beijing Natural Science Foundation Haidian original innovation joint fund (L222123). Wei Yue reports grants from Tianjin Health Commission Science and Technology Projects (TJWJ2021QN061 and ZC20134), and Tianjin Key Medical Discipline (Specialty) Construction Project (No. TJYXZDXK-052B).

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Acknowledgements

We gratefully acknowledge all the participants, clinicians, statisticians, and laboratory and imaging technicians.

Author information

Author notes

  1. Guojuan Chen and Anxin Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, No.6 Jizhao Road, Shuanggang Town, Jinnan District, Tianjin, 300350, China

    Guojuan Chen & Wei Yue

  2. Department of Neurology, Tangshan Gongren Hospital, Tangshan, China

    Guojuan Chen

  3. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Anxin Wang, Xiaoli Zhang, Xue Xia & Jing Li

  4. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Anxin Wang, Xiaoli Zhang, Xue Xia & Jing Li

  5. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China

    Yuhao Li & Xue Tian

  6. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China

    Yuhao Li & Xue Tian

  7. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China

    Zhongrong Miao

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Contributions

GC and AW conducted the statistical analysis, interpreted the data, and drafted the manuscript. XZ, YL, XX, XT, and JL interpreted the data, and commented on the drafts. ZM performed the study. WY supervised the analysis, interpreted the data, and commented on the drafts. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Wei Yue.

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Conflicts of Interest

None declared.

Ethical Approval/Informed consent

This study (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) has been approved by the institutional review board of all the centers. The number of the approval was KY2017-048-01.

Clinical Trial Registration

ClinicalTrials.gov: NCT03370939.

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Chen, G., Wang, A., Zhang, X. et al. Systemic Immune-Inflammation Response is Associated with Futile Recanalization After Endovascular Treatment. Neurocrit Care (2024). https://doi.org/10.1007/s12028-023-01930-y

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