Can Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios Predict the Risk of Developing New Ischemic Lesions After Carotid Stenting?

Abstract

Aim: It has been reported that the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are associated with carotid artery stenosis rate, risk of restenosis after stenting, and clinical outcome after an ischemic stroke, and are also predictive markers. The objective of this study is to evaluate whether NLR and PLR values and the associated temporal changes are indicators of the risk for newly developing ischemic lesions. Material and Methods: Patients who underwent stenting in our clinic between November 2019 and January 2022 and who had a complete blood count and a diffusion magnetic resonance imaging scan before and after the procedure, were included in the study and evaluated in two groups; patients with and without newly developing ischemic lesions. Results: Newly developing ischemic lesions were detected in 27 of the 50 patients included in the study. There was no difference in baseline and 48th-hour NLR and PLR rates and the temporal variation of these rates between patients with and without newly developing ischemic lesions. Erythrocyte distribution width (RDW) and hemoglobin (HGB) values were higher in the without newly developing ischemic lesions group at 48 hours, but there was only a significant difference between the RDW temporal change between the two groups. In the correlation analysis, no significant correlation was found between NLR, PLR, and their temporal changes, ipsilateral and contralateral stenosis rates, age, and residual stenosis rates. Conclusion: There was no significant relationship between the development of newly developing ischemic lesions and NLR and PLR values and the associated temporal changes.

Keywords

• Carotid stenosis
• stents
• neutrophil
• lymphocyte
• platelet
• red cell distribution width.

Kaynakça

1. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685-95.
2. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in europe and trends for the 21st century. Presse Médicale. 2016;45:391-8.
3. Petty GW, Brown Jr RD, Whisnant JP, et al. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;30:2513-6.
4. Bonati LH, Kakkos S, Berkefeld J, et al. European Stroke organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J. 2021;6:1-47.
5. Barbato JE, Dillavou E, Horowitz MB, et al. A randomized trial of carotid artery stenting with and without cerebral protection. J Vasc Surg. 2008;47:760-5.
6. Yabalak A, Yilmaz M. Carotid artery stenting with or without distal filter-type embolic protection device: a single center experience. J Bionic Mem. 2021;1:41-9.
7. Lievens D, von Hundelshausen P. Platelets in atherosclerosis. Thromb Haemost. 2011;106:827-38.
8. Açar G, Kalkan ME, Avci A, et al. The relation of platelet–lymphocyte ratio and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion. Clin Appl Thromb. 2015;21:462-8.

9. Pereira-Neves A, Fragão-Marques M, Rocha-Neves J, et al. the impact of neutrophil-tolymphocyte ratio and plateletto-lymphocyte ratio in carotid artery disease. Port J Card Thorac Vasc Surg. 2021;28:45-51.
10. Deniz M, Ozgun P, Ozdemir E. Relationships between rdw, nlr, car, and apache ii scores in the context of predicting the prognosis and mortality in icu patients. Eur Rev Med Pharmacol Sci. 2022;26:4258-67.
11. Chen C, Gu L, Chen L, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential predictors of prognosis in acute ischemic stroke. Front Neurol. 2021;11:525621.
12. Gökhan S, Ozhasenekler A, Durgun HM, et al. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013;67:11-3.
13. Corriere T, Di Marca S, Cataudella E, et al. Neutrophil-to-lymphocyte ratio is a strong predictor of atherosclerotic carotid plaques in older adults. Nutr Metab Cardiovasc Dis. 2018;28:23-7.
14. Varım C, Varım P, Acar BA, et al. Usefulness of the platelet-to-lymphocyte ratio in predicting the severity of carotid artery stenosis in patients undergoing carotid angiography. Kaohsiung J Med Sci. 2016;32:86-90.
15. Hyun S, Kwon S, Cho S, et al. Can the neutrophil-to-lymphocyte ratio appropriately predict carotid artery stenosis in patients with ischemic stroke?—a retrospective study. J Stroke Cerebrovasc Dis. 2015;24:2646-51.
16. Jiang H, Zhang J, Wu J, et al. Neutrophil-to-lymphocyte ratio correlates with severity of extracranial carotid stenosis—a study using digital subtraction angiography. J Stroke Cerebrovasc Dis. 2017;26:1182-90.
17. Deşer SB, Yucel SM, Demirag MK, et al. The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy. Vascular. 2019;27:604-11.
18. Keskin M, Öcal L, Cerşit S, et al. The predictive role of a novel risk index in patients undergoing carotid artery stenting: systemic immune-inflammation index. J Stroke Cerebrovasc Dis. 2021;30:105955.
19. Dai Z, Li R, Zhao N, et al. Neutrophil to lymphocyte ratio as a predictor of restenosis after angioplasty and stenting for asymptomatic carotid stenosis. Angiology. 2019;70:160-5.
20. Bao X, Zhou G, Xu W, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: novel markers for the diagnosis and prognosis in patients with restenosis following cas. Biomark Med. 2020;14:271–82.
21. Howard G, Roubin GS, Jansen O, et al. Carotid stenting trialists' collaboration. association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 2016;387:1305-11.
22. Furer A, Finkelstein A, Halkin A, et al. High red blood cell distribution width and preclinical carotid atherosclerosis. Biomarkers. 2015;20:376-81.
23. Wen Y. High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol. 2010;15:37.
24. Feng GH, Li HP, Li QL, et al. Red blood cell distribution width and ischaemic stroke. Stroke Vasc Neurol. 2017;2:172-5.