Study On Early Complication Prediction In Acute Ischemic Stroke Due To Large Vessel Occlusion In Anterior Circulation After Successful Endovascular Recanalization

BackgroundEndovascular mechanical thrombectomy(EMT)is a safe and effective treatment for acute ischemic stroke(AIS)caused by intracranial large vessel occlusion(LVO)in anterior circulation.Despite successful recanalization via EMT,some patients remain functional dependence at 3 months after stroke onset(called futile recanalization),which is associated with early complications during the acute phase,such as brain herniation and symptomatic hemorrhagic transformation(sHT).Prediction of early complications is of critical importance to guide early clinical decision-making to improve prognosis.ObjectiveThis study aimed to find plasma biomarkers that have predictive value for early complications for patients with acute ischemic stroke(AIS)due to LVO after recanalization by EMT.MethodsThis is an observational study from one center.From November 2017 to May 2019,we prospectively selected 61 patients with AIS due to LVO in anterior circulation who achieved recanalization via EMT.Plasma samples between 18 and 24 hours after recanalization were obtained for measurements of plasma biomarkers,which were used for retrospective analysis with regard to predictive value for unfavorable clinical outcomes.The primary outcome of this study was overall early complications within 7 days after EMT,defined as the occurrences of any early complications including early neurological deterioration(END),sHT,brain herniation,and malignant brain edema(MBE).The secondary outcome was futile recanalization,defined as successful recanalization plus modified Rankin scale[mRS]score≥3 at 90 days following EMT.Both overall early complications and futile recanalization were regarded as unfavorable outcomes.Univariable and multivariable logistic regression analyses were applied to explore the plasma biomarkers that can serve as independent predictors of early complications,and to investigate whether plasma biomarkers combined with clinical indicators could enhance the predictive value of early complications and futile recanalization.The statistical analyses were performed using SPSS,R and MedCalc software in the present study.ResultsMultivariable logistic regression showed that age and baseline NIHSS score were independent predictors of both overall early complications and futile recanalization.Univariable logistic regression for plasma biomarkers demonstrated that increased levels of matrix metalloproteinase-9(MMP-9),Tenascin-C,C-reactive protein(CRP),Thioredoxin,and decreased levels of A disintegrin and metalloproteinase with a thrombospondin motif repeats 13(ADAMTS13),and Gelsolin were associated with both overall early complications and futile recanalization(all P<0.05).After adjustment for age and baseline NIHSS score,MMP-9,Tenascin-C,Thioredoxin,AD AMTS 13,and Gelsolin were independently associated with both overall early complications and futile recanalization(all P<0.05).CRP was independently associated with overall early complications(P=0.031)while at the limit of significance for futile recanalization(P=0.051).The baseline clinical model(BCM)(including age and baseline NIHSS score)predicted overall early complications with area under the curve(AUC)of 0.749(95%confidence interval[CI]0.611-0.887)and futile recanalization with AUC of 0.807(95%CI 0.693-0.921).The addition of single plasma biomarker to BCM did not significantly improve the AUC value of BCM assessed with DeLong method.Considering all the panels with addition of two plasma biomarkers to BCM,the following panels,including BCM+MMP-9+Tenascin-C,BCM+MMP-9+CRP,BCM+MMP-9+ADAMTS13,BCM+Tenascin-C+ADAMTS13,and BCM+CRP+ADAMTS13,all improved the discrimination of BCM to predict overall early complications(AUC[95%CI]:0.868[0.766-0.970],0.882[0.773-0.990],0.886[0.788-0.984],0.880[0.783-0.977],0.863[0.764-0.962],respectively,all P<0.05 by DeLong method),and significantly improved the predictive value for overall early complications(integrated discrimination improvement[IDI]:19.7%,25.7%,23.4%,19.3%,18.7%,all P<0.05);net reclassification improvement[NRI]:59.1%,71.8%,51.1%,67.4%,38.3%,all P<0.05).Considering all the panels adding two plasma biomarkers to BCM,only BCM+MMP-9+Thioredoxin enhanced discrimination of BCM to predict futile recanalization(AUC[95%CI]0.908[0.839-0.978],P=0.043)and the predictive value for futile recanalization(IDI 20.9%;NRI 67.2%,P<0.001).ConclusionFor patients with AIS due to LVO in anterior circulation who achieved recanalization by EMT,the increased levels of MMP-9,Tenascin-C,CRP,Thioredoxin and decreased levels of ADAMTS13 and Gelsolin within 18-24 hours after EMT were independent predictors of overall early complications.Adding two biomarkers to BCM(including age and baseline NIHSS score)substantially enhanced the predictive value for overall early complications.