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. 2023 Oct;10(10):1714-1724.
doi: 10.1002/acn3.51861. Epub 2023 Aug 2.

Impact of lipid profiles on parenchymal hemorrhage and early outcome after mechanical thrombectomy

Jie Li #  1   2   3 , Ling Long #  4 , Heng Zhang #  1   2   3 , Junliu Zhang #  1   2   3 , Adilijiang Abulimiti  2 , Nuerbiya Abulajiang  2 , Qingbo Lu  2 , Wei Yan  2 , Thanh N Nguyen  5 , Xiaodong Cai  1   3
Affiliations

Impact of lipid profiles on parenchymal hemorrhage and early outcome after mechanical thrombectomy

Jie Li et al. Ann Clin Transl Neurol. 2023 Oct.

Abstract

Objective: We aimed to investigate the association of lipid parameters with parenchymal hemorrhage (PH) and early neurological improvement (ENI) after mechanical thrombectomy (MT) in stroke patients.

Methods: We retrospectively analyzed consecutive patients who underwent MT between January 2019 and February 2022 at a tertiary stroke center. PH was diagnosed and classified as PH-1 and PH-2 according to the European Cooperative Acute Stroke Study definition. ENI was defined as a decrease in the National Institutes of Health Stroke Scale (NIHSS) score by ≥8 or an NIHSS score of ≤1 at 24 h after MT.

Results: Among 155 patients, PH occurred in 41 (26.5%) patients, and 34 (21.9%) patients achieved ENI. In multivariate analysis, lower triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) value (OR = 0.51; 95% CI 0.30-0.89; p = 0.017) and higher HDL-C level (OR = 5.83; 95% CI 1.26-26.99; p = 0.024) were independently associated with PH. The combination of TG <0.77 mmol/L and HDL-C ≥ 0.85 mmol/L was the strongest predictor of PH (OR = 10.73; 95% CI 2.89-39.87; p < 0.001). A low HDL-C level was an independent predictor of ENI (OR 0.13; 95% CI 0.02-0.95; p = 0.045), and PH partially accounts for the failure of ENI in patients with higher HDL-C levels (estimate: -0.05; 95% CI: -0.11 to -0.01; p = 0.016).

Interpretation: The combination of lower TG level and higher HDL-C level can predict PH after MT. Postprocedural PH partially accounts for the failure of ENI in patients with higher HDL-C levels. Further studies into the pathophysiological mechanisms underlying this observation are of interest.

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Conflict of interest statement

T. Nguyen reports research support from Medtronic and the Society of Vascular and Interventional Neurology.

Figures

Figure 1
Figure 1
Receiver‐operating characteristic curve analysis showing the predictive power of TG, HDL‐C, TG/HDL‐C, and TG‐HDL‐C (combined binary variates TG and HDL‐C) for PH (A) and PH‐2 (B) in AIS patients after MT. The predictive ability of TG‐HDL‐C for PH and PH‐2 was significantly better than that of TG, HDL‐C, and TG/HDL‐C. AIS, acute ischemic stroke; HDL‐C, high‐density lipoprotein cholesterol; MT, mechanical thrombectomy; PH, parenchymal hemorrhage; TG, triglyceride.
Figure 2
Figure 2
A combination of binary variates TG and HDL‐C for predicting PH (A) and PH‐2 (B) in AIS patients who underwent MT. The combination of TG <0.77 mmol/L and HDL‐C ≥ 0.85 mmol/L was the strongest predictor of PH, and the combination of TG <0.80 mmol/L and HDL‐C ≥ 0.87 mmol/L was the strongest predictor of PH‐2. AIS, acute ischemic stroke; HDL‐C, high‐density lipoprotein cholesterol; MT, mechanical thrombectomy; PH, parenchymal hemorrhage; TG, triglyceride.
Figure 3
Figure 3
Causal mediation analysis is shown for the presence of parenchymal hemorrhage as a mediator in the relation between HDL‐C levels and early neurological improvement. The mediation effect is the indirect effect expressed as a percentage of the total effect. HDL‐C, high‐density lipoprotein cholesterol.
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