Search

Abstract: Objective To investigate the effects of chitinase protein-40 (YKL-40) and cysteine proteolytic enzyme-1 (Caspase-1) levels and ASPECTS on the prognosis of patients with anterior circulation massive cerebral infarction (MCI) after interventional thrombectomy. Methods Data of 180 patients with anterior circulation MCI who received interventional thrombectomy in The First Hospital of Hebei Medical University from June 2020 to February 2023 were retrospectively analyzed. The patients were divided into the death group (41 cases) and the survival group (139 cases) according to the prognosis 3 months after interventional thrombectomy. Baseline data and YKL-40 and Caspase-1 levels before interventional thrombectomy were compared between the two groups. Cox regression analysis was used to explore the prognostic factors of interventional thrombectomy for MCI. ROC curve analysis was used to assess the efficacy of YKL-40 and Caspase-1 levels and ASPECTS in predicting the prognosis of patients with MCI after interventional thrombectomy. Results The age and infarct area of the death group were higher than those of the survival group, while the ASPECTS were lower (all P＜0.001). Serum YKL-40 level [(141.37±12.40) μg/L vs. (115.05±11.40) μg/L] and Caspase-1 level [(13.05±1.15) ng/L vs. (8.61±0.64) ng/L] in the death group were higher than those in the survival group (all P＜0.001). Cox regression analysis showed that large infarct area (HR 1.011, 95%CI 1.001-1.022), high YKL-40 level (HR 1.033, 95%CI 1.001-1.066), and high Caspase-1 level (HR 1.576, 95%CI 1.264-1.966) were independent risk factors for death after interventional thrombectomy of anterior circulation MCI, while the high ASPECTS (HR 0.887, 95%CI 0.794-0.991) was the protective factor for death after interventional thrombectomy of anterior circulation MCI. ROC curve analysis results showed that the combined prediction of serum YKL-40 and Caspase-1 levels and ASPECTS yielded a better predictive accuracy (AUC 0.940, 95%CI 0.890-0.990) than any of these three indexes alone in predicting death after interventional thrombectomy of anterior circulation MCI [the AUC was 0.869 (95%CI 0.806-0.933), 0.897 (95%CI 0.828-0.966), and 0.724 (95%CI 0.642-0.806), respectively]. Conclusions YKL-40 and Caspase-1 levels and ASPECTS were closely related to the prognosis of patients with anterior circulation MCI after interventional thrombectomy. Consequently, these indexes could be used as prognostic indicators.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the predictive value of high-resolution magnetic resonance vessel wall imaging(HR-VWI combined with diffusion-weighted imaging Alberta Stroke Program Early CT Score (DWI-ASPECTS) based on DWI in short-term prognosis evaluation of acute ischemic stroke (AIS). Methods From September 2020 to September 2022, 483 patients with AIS admitted to our hospital were divided into 394 cases into the good prognosis group with modified Rankin Scale (mRS) score of 0-2 (394) and poor prognosis group with mRS score of 3-5 (89) at 3-month follow-up. The clinical data, differences in HR-VWI parameters including lumen area (LA),wall area (WA),degree of lumen stenosis, plaque load, plaque intensification rate, and remodeling index, and DWI-ASPECTS at the time of admission were compared between the two groups. Multiple linear regression was used to analyze the risk factors for poor short-term prognosis. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of HR-VWI combined with DWI-ASPECTS on the short-term prognosis of patients with AIS. Results The time from onset of stroke to hospital admission was significantly shorter (P＜0.001) in the good-prognosis group [ (3.36±1.15) h] than in the poor-prognosis group [ (5.21±2.03) h]. The National Institutes of Health Stroke Scale (NIHSS) score in the good-prognosis group (10.53±1.18) was also significantly lower (P＜0.001) than that of the poor-prognosis group (11.68±1.23). The LA [ (45.58±5.04) mm] and DWI-ASPECTS (7.56±1.01) in the good prognosis group were significantly greater (P＜0.05) than those in the poor prognosis group (43.37±4.89, 6.02±1.05) whereas the WA [ (27.05±2.83) mm], degree of lumen stenosis (50.26±5.58),plaque load (44.56±5.16),plaque enhancement rate (54.48±6.23),and remodeling index (0.94±0.12) in the good-prognosis group were significantly smaller (P＜0.05) than those in the poor prognosis group (30.17±3.05, 52.37±6.01, 47.10±4.74, 57.06 ±5.98, 1.02 ±0.15). Multiple linear regression analysis showed that time from onset to admission, NIHSS score, degree of lumen stenosis, plaque load, remodeling index, and DWI-ASPECTS were all independent factors affecting the short-term prognostic of AIS patients (P＜0.05). The area under the ROC curve (AUC) of poor short-term prognosis prediction was 0.742 (95%CI: 0.653-0.831) for the degree of lumen stenosis, 0.770 (95%CI: 0.683-0.856) for plaque load, 0.753 (95%CI: 0.667-0.839) for remodeling index, 0.761 (95%CI:0.673-0.849) for DWI-ASPECTS, and 0.859 (95%CI: 0.795-0.924) for the combined factors. Conclusion The combination of HR-VWI and DWI-ASPECTS has good predictive value in short-term prognosis evaluation of AIS. [ABSTRACT FROM AUTHOR]

Objective To evaluate the prognostic value of neutrophil/lymphocyte ratio (NLR) combined with Alberta Stroke Program Early CT (ASPECT) score in patients with acute ischemic stroke with large vessel occlusion (AIS-LVO) treated with intravenous thrombolytic therapy. Methods Totally 161 patients with AIS-LVO who received intravenous thrombolytic therapy were retrospectively selected. Laboratory, imaging and clinical data were collected to obtain NLR and ASPECT score. According to the modified Rankin scale (mRS) score 90 days after onset, the patients were divided into the poor prognosis group (90 cases) and good prognosis group (71 cases) . The clinical data results of the two groups were compared. We analyzed the relationship between NLR, ASPECT score and poor neurological prognosis in patients with AIS-LVO, and the value of NLR and ASPECT score in predicting poor neurological prognosis. Results Age, proportion of atrial fibrillation, proportion of collateral circulation grade 0-1, NIHSS score on admission, proportion of vascular recanalization failure, proportion of intracranial hemorrhage and preoperative NLR in the poor prognosis group were higher than those in the good prognosis group (all P<0. 05), but preoperative ASPECT score was lower than that of the good prognosis group (P<0. 05) . Logistic regression analysis showed that grade 0-1 of collateral circulation, vascular recanalization failure, preoperative ASPECT score<7, and preoperative NLR≥1. 86 were the risk factors for poor prognosis in patients with AIS-LVO afterintravenous thrombolytic therapy (all P<0. 05) . The cut-off value of NLR and ASPECT score in predicting poor prognosis of AIS-LVO patients after intravenous thrombolytic therapy was 1. 89 and 7 points, and the area under the curve was 0. 726 and 0. 783, respectively. The area under the curve of NLR combined with ASPECT score in predicting poor prognosis was 0. 923, which were higher than that of NLR or ASPECT score alone (Z=4. 772, 4. 207, both P< 0. 05) . Conclusion High NLR and low ASPECTS score are associated with poor prognosis of AIS-LVO patients after intravenous thrombolytic therapy, and NLR combined ASPECTS score can better predict the occurrence of poor prognosis after intravenous thrombolytic therapy of AIS-LVO patients. [ABSTRACT FROM AUTHOR]