Astrocytic reaction; endovascular therapy; inflammation; ischemic stroke; Chitinase-3-Like Protein 1; CHI3L1 protein, human; Biomarkers; Humans; Male; Female; Aged; Middle Aged; Prospective Studies; Treatment Outcome; Recovery of Function; Aged, 80 and over; Biomarkers/blood; Endovascular Procedures/methods; Chitinase-3-Like Protein 1/blood; Ischemic Stroke/therapy; Ischemic Stroke/blood; Ischemic Stroke/surgery; Astrocytes/pathology; Astrocytes/metabolism; Neurology (clinical); Cardiology and Cardiovascular Medicine
Abstract :
[en] [en] INTRODUCTION: More than 50% of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT) remain severely disabled at 3 months. We hypothesized that acute astrocytic inflammatory response may play a pivotal role in post-AIS brain changes associated with poor functional outcome. We proposed to evaluate the level of YKL-40, a glycoprotein mainly released by reactive astrocytes.
PATIENTS AND METHODS: A monocentric prospective cohort study was conducted on consecutive LVO AIS patients treated with EVT. Three blood samples (before, within 1 and 24-hour post-EVT) were collected to measure plasma YKL-40 concentrations. Functional outcome was assessed according to the modified Rankin Scale (mRS) score at 3 months.
RESULTS: Between 2016 and 2020, 120 patients were included. The plasma concentration of YKL-40 before EVT was statistically and independently associated with 3-month worse functional outcome (adjusted cOR, 1.59; 95% CI [1.05-2.44], p = 0.027) but not the two following samples 1-hour and 24-hour post-EVT. Accordingly, we found that excellent functional outcome was associated with a lower level of YKL-40 before and within 1 h after EVT (p = 0.005 and p = 0.003, respectively) but not when measured 24 h after EVT (p = 0.2).
DISCUSSION AND CONCLUSION: This study suggests that the astrocytic reaction to acute brain hypoxia, especially before recanalization, is associated with worse functional outcome. Such early biomarker of the astrocytic response in AIS may optimize individualized care in the future.
CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02900833.
Disciplines :
Neurology
Author, co-author :
Boutelier, Ada ; Cognitive Neurology Center, GHU APHP Nord, Hôpital Lariboisière-Fernand Widal, Université Paris Cité, Paris, France ; Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, U1144 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
Ollivier, Véronique; Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, U1144 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
Mazighi, Mikael; Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, U1144 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France ; Biological Resource Center and Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France ; FHU NeuroVasc, Paris, France ; Department of Neurology, GHU APHP NORD, Hôpital Lariboisière, Paris, France
Kyheng, Maeva; CHU Lille, Department of Biostatistics, Lille, France
Labreuche, Julien; Stroke-Link F-CRIN Research Network, Lille, France ; CHU Lille, Department of Biostatistics, Lille, France
Brikci-Nigassa, Nahida; Biological Resource Center and Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
Solo Nomenjanahary, Mialitiana; Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, U1144 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Biological Resource Center and Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
Maier, Benjamin; Stroke-Link F-CRIN Research Network, Lille, France ; Biological Resource Center and Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
Paquet, Claire; Cognitive Neurology Center, GHU APHP Nord, Hôpital Lariboisière-Fernand Widal, Université Paris Cité, Paris, France
Ho-Tin-Noe, Benoit; Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, U1144 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France
Desilles, Jean-Philippe; Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, U1144 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France ; Biological Resource Center and Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France ; FHU NeuroVasc, Paris, France
Language :
English
Title :
Acute astrocytic reaction is associated with 3-month functional outcome after stroke treated with endovascular therapy.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Agence Nationale de la Recherche, Grant/Award Number: ANR-16-RHUS-0004 (RHU TRT_cSVD) ANR-18-RHUS-0001 (RHU Booster) and ANR-22-CE17-0032 (INFLAME).
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