Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma
Purpose Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Interventional Neuroradiology
2023-11-01
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| Series: | Neurointervention |
| Subjects: | |
| Online Access: | http://neurointervention.org/upload/pdf/neuroint-2023-00269.pdf |
| _version_ | 1797327059294355456 |
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| author | Seoiyoung Ahn Steven G. Roth Jacob Jo Yeji Ko Nishit Mummareddy Matthew R. Fusco Rohan V. Chitale Michael T. Froehler |
| author_facet | Seoiyoung Ahn Steven G. Roth Jacob Jo Yeji Ko Nishit Mummareddy Matthew R. Fusco Rohan V. Chitale Michael T. Froehler |
| author_sort | Seoiyoung Ahn |
| collection | DOAJ |
| description | Purpose Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is to investigate the association between LDL-C and delayed parenchymal hematoma (PH) that was not seen on immediate post-thrombectomy dual-energy computed tomography (DECT). Materials and Methods A retrospective analysis was conducted on all patients with anterior circulation large vessel occlusion who underwent thrombectomy at a comprehensive stroke center from 2018–2021. Per institutional protocol, all patients received DECT immediately post-thrombectomy and magnetic resonance imaging or CT at 24 hours. The presence of immediate hemorrhage was assessed by DECT, while delayed PH was assessed by 24-hour imaging. Multivariable analysis was performed to identify predictors of delayed PH. Patients with hemorrhage on immediate post-thrombectomy DECT were excluded to select only those with delayed PH. Results Of 159 patients without hemorrhage on immediate post-thrombectomy DECT, 18 (11%) developed delayed PH on 24-hour imaging. In multivariable analysis, LDL-C (odds ratio [OR], 0.76; P=0.038; 95% confidence interval [CI], 0.59–0.99; per 10 mg/dL increase) independently predicted delayed PH. High-density lipoprotein cholesterol, triglyceride, and statin use were not associated. After adjusting for potential confounders, LDL-C ≤50 mg/dL was associated with an increased risk of delayed PH (OR, 5.38; P=0.004; 95% CI, 1.70–17.04), while LDL-C >100 mg/dL was protective (OR, 0.26; P=0.041; 95% CI, 0.07–0.96). Conclusion LDL-C ≤50 mg/dL independently predicted delayed PH following thrombectomy and LDL-C >100 mg/dL was protective, irrespective of statin. Thus, patients with low LDL-C levels may warrant vigilant monitoring and necessary interventions, such as blood pressure control or anticoagulation management, following thrombectomy even in the absence of hemorrhage on immediate post-thrombectomy DECT. |
| first_indexed | 2024-03-08T06:33:02Z |
| format | Article |
| id | doaj.art-18228378449446c9bc27a262a896e07d |
| institution | Directory Open Access Journal |
| issn | 2093-9043 2233-6273 |
| language | English |
| last_indexed | 2024-03-08T06:33:02Z |
| publishDate | 2023-11-01 |
| publisher | Korean Society of Interventional Neuroradiology |
| record_format | Article |
| series | Neurointervention |
| spelling | doaj.art-18228378449446c9bc27a262a896e07d2024-02-03T11:07:49ZengKorean Society of Interventional NeuroradiologyNeurointervention2093-90432233-62732023-11-0118317218110.5469/neuroint.2023.00269405Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal HematomaSeoiyoung Ahn0Steven G. Roth1Jacob Jo2Yeji Ko3Nishit Mummareddy4Matthew R. Fusco5Rohan V. Chitale6Michael T. Froehler7 Vanderbilt University School of Medicine, Nashville, TN, USA Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA Vanderbilt University School of Medicine, Nashville, TN, USA Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USAPurpose Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is to investigate the association between LDL-C and delayed parenchymal hematoma (PH) that was not seen on immediate post-thrombectomy dual-energy computed tomography (DECT). Materials and Methods A retrospective analysis was conducted on all patients with anterior circulation large vessel occlusion who underwent thrombectomy at a comprehensive stroke center from 2018–2021. Per institutional protocol, all patients received DECT immediately post-thrombectomy and magnetic resonance imaging or CT at 24 hours. The presence of immediate hemorrhage was assessed by DECT, while delayed PH was assessed by 24-hour imaging. Multivariable analysis was performed to identify predictors of delayed PH. Patients with hemorrhage on immediate post-thrombectomy DECT were excluded to select only those with delayed PH. Results Of 159 patients without hemorrhage on immediate post-thrombectomy DECT, 18 (11%) developed delayed PH on 24-hour imaging. In multivariable analysis, LDL-C (odds ratio [OR], 0.76; P=0.038; 95% confidence interval [CI], 0.59–0.99; per 10 mg/dL increase) independently predicted delayed PH. High-density lipoprotein cholesterol, triglyceride, and statin use were not associated. After adjusting for potential confounders, LDL-C ≤50 mg/dL was associated with an increased risk of delayed PH (OR, 5.38; P=0.004; 95% CI, 1.70–17.04), while LDL-C >100 mg/dL was protective (OR, 0.26; P=0.041; 95% CI, 0.07–0.96). Conclusion LDL-C ≤50 mg/dL independently predicted delayed PH following thrombectomy and LDL-C >100 mg/dL was protective, irrespective of statin. Thus, patients with low LDL-C levels may warrant vigilant monitoring and necessary interventions, such as blood pressure control or anticoagulation management, following thrombectomy even in the absence of hemorrhage on immediate post-thrombectomy DECT.http://neurointervention.org/upload/pdf/neuroint-2023-00269.pdfstrokeendovascular thrombectomyhemorrhagic transformationparenchymal hematomalow-density lipoprotein cholesterol |
| spellingShingle | Seoiyoung Ahn Steven G. Roth Jacob Jo Yeji Ko Nishit Mummareddy Matthew R. Fusco Rohan V. Chitale Michael T. Froehler Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma Neurointervention stroke endovascular thrombectomy hemorrhagic transformation parenchymal hematoma low-density lipoprotein cholesterol |
| title | Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma |
| title_full | Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma |
| title_fullStr | Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma |
| title_full_unstemmed | Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma |
| title_short | Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma |
| title_sort | low levels of low density lipoprotein cholesterol increase the risk of post thrombectomy delayed parenchymal hematoma |
| topic | stroke endovascular thrombectomy hemorrhagic transformation parenchymal hematoma low-density lipoprotein cholesterol |
| url | http://neurointervention.org/upload/pdf/neuroint-2023-00269.pdf |
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