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The Association of Whole Blood Viscosity with Clinical Outcomes After Mechanical Thrombectomy for Acute Ischemic Stroke

Year 2021, Volume: 18 Issue: 1, 24 - 28, 28.04.2021
https://doi.org/10.35440/hutfd.843952

Abstract

Background: Blood viscosity (BV) is relationship cerebrovascular events. However, the association with between BV and clinical outcomes after acute ischemic stroke (AIS) has not been studied. This study evaluated the relationship between whole blood viscosity (WBV) and clinical outcomes after AIS.
Materials and Methods: The study enrolled 240 consecutive patients with AIS who underwent mechanical thrombectomy (MT) between 2017 and 2019 years. The all patients were divided according to the modified Rankin Scale (mRS) score, as good (mRS 0–2) and poor (mRS 3–6) clinical outcomes group. WBV was calculated by the formula derived from total protein and haematocrit levels.
Results: Poor clinical outcomes group presented significantly higher WBV values both at LSR and HSR (p < 0.001). Multivariate analysis, both high WBV at LSR (Odd ratio: 2.679, p < 0.001) and high WBV at HSR (Odd ratio: 1.278, p < 0.001) were independent predictors for poor clinical outcomes. In receiver operating characteristic analysis, value of 16.1 WBV at HSR had 76.7% sensitivity and 76% specificity for predicting poor clinical outcomes and a value of 38.5 WBV at LSR had 75.3% sensitivity and 78% specificity for predicting poor clinical outcomes. There was a significant positive correlation between WBV at LSR and mRS score (0-6) (r = 0.457, p <0.001) and WBV at HSR and mRS score (0-6) (r = 0.452, p <0.001).
Conclusions: Increased WBC may be independent risk factor and correlated with poor clinical outcomes in AIS patients treated with MT.

References

  • References 1. Daniel J. Cho. Blood Viscosity Abnormalities in Large and Small Vessel Diseases: Future Directions for Plasma Medicine. Plasma Medicine 2012; 2: 221–235
  • 2. Ott EO, Lechner H, Aranibar A. High blood viscosity syndrome in cerebral infarction. Stroke 1974;5:330-333.
  • 3. Fisher M, Meiselman HJ. Hemorheological factors in cerebral ischemia. Stroke 1991;22:1164-1169.
  • 4. Grotemeyer KC, Kaiser R, Grotemeyer KH, Husstedt IW. Association of elevated plasma viscosity with small vessel occlusion in ischemic cerebral disease. Thromb Res 2014; 133: 96-100.
  • 5. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015 ; 46:3020–35.
  • 6. Nogueira RG, Liebeskind DS, Sung G, Duckwiler G, Smith WS. Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials. Stroke 2009 ; 40:3777–83.
  • 7. Rankin J. Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scottish Medical Journal. 1957 ; 2:200–215.
  • 8. de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation 1990; 81: 107-117.
  • 9. Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone P, et al. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007; 49: 2379-93.
  • 10. Wu KK. Laboratory studies in arterial thromboembolism. In: Koepke JA, ed. Practical Laboratory Hematology. 2nd ed. New York: Churchill Livingstone; 1991. p.445- 67.
  • 11. Celik T, Balta S, Ozturk C, Iyisoy A. Whole Blood Viscosity and Cardiovascular Diseases: A Forgotten Old Player of the Game. Med Princ Pract. 2016;25:499-500.
  • 12. Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997 ;9: 168-73.
  • 13. Resch KL, Ernst E, Matrai A, Paulsen HF. Fibrinogen and viscosity as risk factors for subsequent cardiovascularevents in stroke survivors. Ann Intern Med 1992; 117: 371 375.
  • 14. Cetin EH, Cetin MS, Canpolat U, Aydin S, Aras D, Topaloglu S, et al. Prognostic significance of whole blood viscosity estimated by de Simone’s formula in ST-elevation myocardial infarction. Biomark Med 2016; 10: 495–511.
  • 15. Çekici Y, Kılıç S, Saraçoğlu E, Çetin M, Veysel Düzen İ, Yılmaz M. The relationship between blood viscosity and Isolated Coronary Artery Ectasia. Acta Cardiol Sin. 2019;35:20-26.
  • 16. Erdogan G, Yenercag M, Arslan U. The Relationship between Blood Viscosity and Acute Arterial Occlusion. Journal of Cardiovascular Emergencies. 2020;6:7-12
  • 17. Song SH, Kim JH, Lee JH, Yun YM, Choi DH, Kim HY. Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke. BMC Neurology. 2017;17:20.
  • 18. Furukawa K, Abumiya T, Sakai K, Hirano M, Osanai T, Shichinohe H, et al. Increased Blood Viscosity in Ischemic Stroke Patients with Small Artery Occlusion Measured by an Electromagnetic Spinning Sphere Viscometer. J Stroke Cerebrovasc Dis. 2016;25:2762-2769.
  • 19. Fisher M, Meiselman HJ. Hemorheological factors in cerebral ischemia. Stroke 1991; 22: 1164-1169.
  • 20. Li RY, Cao ZG, Li Y, Wang RT. Increased whole blood viscosity is associated with silent cerebral infarction. Clin Hemorheol Microcirc 2015; 59: 301-307
  • 21. Nogueira RG, Smith WS; MERCI and Multi MERCI Writing Committee. Safety and efficacy of endovascular thrombectomy in patients with abnormal hemostasis: pooled analysis of the MERCI and multi MERCI trials. Stroke 2009;40:516–22.
  • 22. Linfante I, Starosciak AK, Walker GR, Dabus G, Castonguay AC, Gupta R5, et al. Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry.J Neurointerv Surg. 2016;8:224-9.
  • 23. Tonetti DA, Desai SM, Casillo S, Stone J, Brown M, Jankowitz B, et al. Successful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy. J Neurointerv Surg. 2019-015330.
  • 24. Gordon WR, Salamo RM, Behera A, Chibnall J, Alshekhlee A, Callison RC, et al. Association of blood glucose and clinical outcome after mechanical thrombectomy for acute ischemicstroke. Interv Neurol 2018; 7: 182–188.
  • 25. Goyal N, Tsivgoulis G, Chang JJ, Malhotra K, Pandhi A, Ishfaq MF, et al. Neutrophil-to-lymphocyte ratio as a prognostic biomarker of outcomes in large vessel occlusion strokes. Stroke 2018; 49: 1985-1987.
  • 26. Wang H, Zhang M, Hao Y, Zi W, Yang D, Zhou Z, et al. Early Prediction of Poor Outcome Despite Successful Recanalization After Endovascular Treatment for Anterior Large Vessel Occlusion Stroke. World Neurosurg. 2018; 115:e312-e32

Akut İskemik İnme İçin Mekanik Trombektomi Sonrası Klinik Sonuçlarla Tam Kan Viskozitesinin İlişkisi

Year 2021, Volume: 18 Issue: 1, 24 - 28, 28.04.2021
https://doi.org/10.35440/hutfd.843952

Abstract

Öz.
Akut İskemik İnme İçin Mekanik Trombektomi Sonrası Klinik Sonuçlarla Tam Kan Viskozitesinin İlişkisi
Amaç: Artmış kan viskozitesi (KV) iskemik inme ile ilişkilidir. Ancak, akut iskemik inme (Aİİ) sonrası kan viskozitesi ve klinik sonuçlar arasındaki ilişki şu ana kadar yeterince değerlendirilmemiştir. Bu çalışmanın amacı tam kan viskozitesi (TKV) ve Aİİ sonrası klinik sonuçlar arasındaki ilişkiyi değerlendirmektir.
Materyal ve metod: Çalışmaya Ocak 2017 - Aralık 2019 tarihleri arasında mekanik trombektomi (MT) yapılan 240 ardışık Aİİ hastası alındı. Hastalar 90. günde değerlendirilen modifiye Rankin Skalası (mRS) skoruna göre iyi klinik sonuç (mRS 0-2) ve kötü klinik sonuç (mRS 3–6) olarak iki gruba ayrıldı. TKV, hem düşük kayma hızında (DKH) hem de yüksek kayma hızında (YKH) hematokrit ve total plazma protein seviyeleri kullanılarak hesaplandı.
Bulgular: Kötü klinik sonuç grubunda TKV hem DKH' de (34.9 ± 0.2'ye karşı 44.9 ± 3.2; p <0.001) hem de YKH'de (15.9 ± 0.28'e karşı 16.4 ± 0.42; p <0.001) anlamlı olarak daha yüksekti. ROC analizinde, YKH' deki TKV' nin 16,1’lik kesme değeri, kötü sonuçları tahmin etmek için % 76,7 duyarlılık ve % 76 özgüllüğe sahipti. DKH'deki TKV’nin 38,5’lik kesme değerikötü klinik sonuçları tahmin etmek için % 75,3 duyarlılık ve % 78 özgüllüğe sahipti. Çok değişkenli analizde, hem DKH'de hem de YKH'deki yüksek TKV değerleri, kötü sonuçlar için bağımsız prediktörler olarak saptandı. DKH'deki TKV değerleri ile mRS skoru (0-6) (r = 0.457, p <0.001) arasında, YKH’deki TKV değerleri ile mRS skoru (0-6) arasında anlamlı pozitif korelasyon vardı (r = 0.452, p <0.001).
Sonuç: Hem DKH de hem de YKH de artmış TKV değerleri, MT ile tedavi edilen Aİİ hastalarında kötü klinik sonuçlar için bağımsız risk faktörü olabilir, mRS skoru ile pozitif korelasyon gösterir.

References

  • References 1. Daniel J. Cho. Blood Viscosity Abnormalities in Large and Small Vessel Diseases: Future Directions for Plasma Medicine. Plasma Medicine 2012; 2: 221–235
  • 2. Ott EO, Lechner H, Aranibar A. High blood viscosity syndrome in cerebral infarction. Stroke 1974;5:330-333.
  • 3. Fisher M, Meiselman HJ. Hemorheological factors in cerebral ischemia. Stroke 1991;22:1164-1169.
  • 4. Grotemeyer KC, Kaiser R, Grotemeyer KH, Husstedt IW. Association of elevated plasma viscosity with small vessel occlusion in ischemic cerebral disease. Thromb Res 2014; 133: 96-100.
  • 5. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015 ; 46:3020–35.
  • 6. Nogueira RG, Liebeskind DS, Sung G, Duckwiler G, Smith WS. Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials. Stroke 2009 ; 40:3777–83.
  • 7. Rankin J. Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scottish Medical Journal. 1957 ; 2:200–215.
  • 8. de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation 1990; 81: 107-117.
  • 9. Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone P, et al. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007; 49: 2379-93.
  • 10. Wu KK. Laboratory studies in arterial thromboembolism. In: Koepke JA, ed. Practical Laboratory Hematology. 2nd ed. New York: Churchill Livingstone; 1991. p.445- 67.
  • 11. Celik T, Balta S, Ozturk C, Iyisoy A. Whole Blood Viscosity and Cardiovascular Diseases: A Forgotten Old Player of the Game. Med Princ Pract. 2016;25:499-500.
  • 12. Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997 ;9: 168-73.
  • 13. Resch KL, Ernst E, Matrai A, Paulsen HF. Fibrinogen and viscosity as risk factors for subsequent cardiovascularevents in stroke survivors. Ann Intern Med 1992; 117: 371 375.
  • 14. Cetin EH, Cetin MS, Canpolat U, Aydin S, Aras D, Topaloglu S, et al. Prognostic significance of whole blood viscosity estimated by de Simone’s formula in ST-elevation myocardial infarction. Biomark Med 2016; 10: 495–511.
  • 15. Çekici Y, Kılıç S, Saraçoğlu E, Çetin M, Veysel Düzen İ, Yılmaz M. The relationship between blood viscosity and Isolated Coronary Artery Ectasia. Acta Cardiol Sin. 2019;35:20-26.
  • 16. Erdogan G, Yenercag M, Arslan U. The Relationship between Blood Viscosity and Acute Arterial Occlusion. Journal of Cardiovascular Emergencies. 2020;6:7-12
  • 17. Song SH, Kim JH, Lee JH, Yun YM, Choi DH, Kim HY. Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke. BMC Neurology. 2017;17:20.
  • 18. Furukawa K, Abumiya T, Sakai K, Hirano M, Osanai T, Shichinohe H, et al. Increased Blood Viscosity in Ischemic Stroke Patients with Small Artery Occlusion Measured by an Electromagnetic Spinning Sphere Viscometer. J Stroke Cerebrovasc Dis. 2016;25:2762-2769.
  • 19. Fisher M, Meiselman HJ. Hemorheological factors in cerebral ischemia. Stroke 1991; 22: 1164-1169.
  • 20. Li RY, Cao ZG, Li Y, Wang RT. Increased whole blood viscosity is associated with silent cerebral infarction. Clin Hemorheol Microcirc 2015; 59: 301-307
  • 21. Nogueira RG, Smith WS; MERCI and Multi MERCI Writing Committee. Safety and efficacy of endovascular thrombectomy in patients with abnormal hemostasis: pooled analysis of the MERCI and multi MERCI trials. Stroke 2009;40:516–22.
  • 22. Linfante I, Starosciak AK, Walker GR, Dabus G, Castonguay AC, Gupta R5, et al. Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry.J Neurointerv Surg. 2016;8:224-9.
  • 23. Tonetti DA, Desai SM, Casillo S, Stone J, Brown M, Jankowitz B, et al. Successful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy. J Neurointerv Surg. 2019-015330.
  • 24. Gordon WR, Salamo RM, Behera A, Chibnall J, Alshekhlee A, Callison RC, et al. Association of blood glucose and clinical outcome after mechanical thrombectomy for acute ischemicstroke. Interv Neurol 2018; 7: 182–188.
  • 25. Goyal N, Tsivgoulis G, Chang JJ, Malhotra K, Pandhi A, Ishfaq MF, et al. Neutrophil-to-lymphocyte ratio as a prognostic biomarker of outcomes in large vessel occlusion strokes. Stroke 2018; 49: 1985-1987.
  • 26. Wang H, Zhang M, Hao Y, Zi W, Yang D, Zhou Z, et al. Early Prediction of Poor Outcome Despite Successful Recanalization After Endovascular Treatment for Anterior Large Vessel Occlusion Stroke. World Neurosurg. 2018; 115:e312-e32
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mustafa Yenerçağ 0000-0002-0933-7852

Çetin Kursad Akpinar 0000-0001-9512-1048

Uğur Arslan 0000-0001-8572-3571

Erdem Gürkaş 0000-0001-8086-2900

Publication Date April 28, 2021
Submission Date December 21, 2020
Acceptance Date March 1, 2021
Published in Issue Year 2021 Volume: 18 Issue: 1

Cite

Vancouver Yenerçağ M, Akpinar ÇK, Arslan U, Gürkaş E. The Association of Whole Blood Viscosity with Clinical Outcomes After Mechanical Thrombectomy for Acute Ischemic Stroke. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021;18(1):24-8.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty