The relationship between first pass recanalization of stent-retriever-based thrombectomy and neutrophil to lymphocyte ratio in middle cerebral artery occlusions

摘要

ABSTRACT Background: Inflammatory response plays an important role in the process of ischemic stroke. Rapid, sustained and complete reperfusion is the most important modifiable prognostic factor for a favorable clinical outcome in patients receiving endovascular treatment (EVT). The studies related to the clot contents regarding the high level of leukocyte clots that are difficult to recan-alize are quite remarkable. We aimed to investigate the relationship between Neutrophil to lymphocyte ratio and recanalization at the first pass thrombectomy. Methods: Study was conducted from February 2015 to December 2018. Patients with stroke were treated with mechanical thrombectomy. The normality of distribution of continuous variables was tested by Shapiro-Wilk test. The Mann-Whitney U test and Chi-square test was used to assess relations between variables. ROC curve analysis was performed to determine the cut-off value for NLR. Results: There were 84 patients included the study, the mean age 62.8 ±12.9; 61.9 (52/84) that were female; median (IQR 25-75) NIHSS 16 (14-19) treated with stent-retriever-based thrombectomy. The distribution of NLR was skewed (p value for 1-sample Kolmogorov-Smirnov test: <0.001). In terms of recanalization outcomes, the patients with NLR < 3.51 showed a significantly higher rates of successful recanalization (AUC — 0.671 ±0.06; p — 0.005). Conclusion: This study demonstrates that higher admission NLR values are independent predictors of unsuccessful recanalization first pass in MCA M1 occlusion of stroke patients treated with mechanical stent-retriever-based thrombectomy. Future large cohort and structural analysis of thrombi studies are needed to further explore the role of NLR as a prognostic neuroinflamma-tory biomarker for successful recanalization in EVT of stroke. List of abbreviations: MCA: middle cerebral artery; NLR: neutrophil to lymphocyte ratio; MT: mechanical thrombectomy; EVT: endovascular treatment; NIHSS: National Institutes of Health Stroke Scale; mTICI: modified thrombolysis in cerebral infarction