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. 2025 Aug 20;30(1):776.
doi: 10.1186/s40001-025-03059-4.

Association between non-traditional lipid parameters and futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy

Jia Duan #  1 , Jian Duan #  1 , Longyi Zheng  2 , Shuang Tang  1 , Shuang Xie  1 , Wenli Xing  1 , Ao Qian  3
Affiliations

Association between non-traditional lipid parameters and futile recanalization in patients with acute ischemic stroke undergoing mechanical thrombectomy

Jia Duan et al. Eur J Med Res. .

Abstract

Background: Non-traditional lipid parameters are crucial biomarkers associated with outcomes of acute ischemic stroke (AIS). We aim to explore the relationship between non-traditional lipid parameters and futile recanalization (FR) following mechanical thrombectomy (MT) for acute large artery occlusion (LAO).

Methods: A retrospective study was conducted in our stroke center. The definition of FR is modified Rankin scale (mRS) score ≥ 3 at 90-day follow-up. The non-traditional lipid parameters include atherogenic index of plasma (AIP), apolipoprotein (Apo) B/A1 ratio, Castelli's risk index (CRI), lipoprotein combine index (LCI), residual lipoprotein cholesterol (RLP-C), and non-high-density lipoprotein cholesterol (non-HDL-C). Multivariate regression analysis was performed to identify independent factors of FR between these parameters, as continuous variables. Then, AIP, Apo B/A1 ratio, CRI-I, and CRI-II, all of which met the significance, were categorized into tertiles to further investigate their relationship with FR through multivariate regression analysis and restricted cubic spline (RCS) curves. Then, linear regression analysis was employed to explore the association between non-traditional lipid parameters and the final infarct volume.

Results: A total of 338 patients were enrolled into this study, and 196 (56.5%) patients experienced FR. AIP, Apo B/A1 ratio, CRI-I, and CRI-II were categorized into tertiles based on value. Compared with patients in the lowest tertile, those in the highest tertile had significantly increased risk of FR (AIP: odds ration [OR] 2.64, 95% CI 1.27-5.51, P = 0.009; Apo B/A1 ratio: OR 2.21, 95% CI 1.12-4.40, P = 0.023; CRI-I: OR 3.41, 95% CI 1.60-7.31, P = 0.002; CRI-II: OR 3.38, 95% CI 1.58-7.21, P = 0.002). RCS curves demonstrated a linear relationship between those four parameters and FR (all Pnon-linear > 0.05). Linear regression analysis confirmed that AIP and CRI-II were positively correlated with the final infarct volume (AIP: β 2.61, 95% CI 0.20-5.03, P = 0.034; CRI-II: β 8.93, 95% CI 1.12-16.74, P = 0.025).

Conclusion: This study provides evidence that AIP, Apo B/A1, CRI-I, and CRI-II are independent risk factors of FR following MT for acute LAO, and can be novel biomarkers of prognosis in patients treated with MT.

Keywords: Acute ischemic stroke; Futile recanalization; Large artery occlusion; Lipid; Mechanical thrombectomy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Suining Central Hospital (KYLLKS20250046). Informed consent was obtained from the participants or their legal representatives. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Process of patient selection
Fig. 2
Fig. 2
Receiver operator characteristic curves demonstrate the discrimination ability of non-traditional lipid parameters for futile recanalization
Fig. 3
Fig. 3
Restricted cubic spline for the association between AIP (a), Apo B/A1 ratio (b), CRI-I (c), CRI-II (d) and futile recanalization. AIP: atherogenic index of plasma; Apo: apolipoprotein; CRI: Castelli’s risk index
Fig. 4
Fig. 4
Subgroup analysis revealing the associations between AIP (a), Apo B/A1 ratio (b), CRI-I (c), CRI-II (d) and futile recanalization under different conditions. AIP: atherogenic index of plasma; Apo: apolipoprotein; CRI: Castelli’s risk index
Fig. 5
Fig. 5
Analysis of the mediating effect of serum glucose at admission on the relationship between CRI-I (a), CRI-II (b) and futile recanalization. DE: direct effect; IE: indirect effect; AIP: atherogenic index of plasma; Apo: apolipoprotein; CRI: Castelli’s risk index
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