Contribution of Serum Lipid Profiles to Outcome After Endovascular Thrombectomy for Anterior Circulation Ischemic Stroke

The contribution of lipids, including low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) and triglycerides (TG), to stroke outcomes is still debated. We sought to determine the impact of LDL-C concentrations on the outcome of patients with ischemic stroke in the anterior circulation who received treatment with endovascular thrombectomy (EVT). We performed a retrospective analysis of consecutive patients with acute ischemic stroke treated at a tertiary center between 2012 and 2016. Patients treated with EVT for large artery occlusion in the anterior circulation were selected. The primary endpoint was functional outcome at 3months as measured with the modified Rankin Scale (mRS). Secondary outcome measures included hospital death and final infarct volume (FIV). Blood lipid levels were determined in a fasting state, 1day after admission. We studied a total of 174 patients (44.8% men) with a median age of 74years (interquartile range [IQR] 61-82) and median National Institutes of Health Stroke Scale at admission of 18 (14-22). Bridging therapy with intravenous tissue-plasminogen activator (t-PA) was administered in 122 (70.5%). The median LDL-C was 90mg/dl (72-115). LDL-C demonstrated a U-type relationship with FIV (p=0.036). Eighty-three (50.0%) patients had an mRS of 0-2 at 3months. This favorable outcome was independently associated with younger age (OR 0.944, 95% CI 0.90-0.99, p=0.012), thrombolysis in cerebral infarction 2b-3 reperfusion (OR 5.12, 95% CI 1.01-25.80, p=0.015), smaller FIV (0.97 per cm(3), 95% CI 0.97-0.99, p<0.001), good leptomeningeal collaterals (OR 5.29, 95% CI 1.48-18.9, p=0.011), and LDL-C more than 77mg/dl (OR 0.179, 95% CI 0.04-0.74, p=0.018). A higher LDL-C concentration early in the course of a stroke caused by large artery occlusion in the anterior circulation is independently associated with a favorable clinical outcome at 3months. Further studies into the pathophysiological mechanisms underlying this observation are warranted.