Introduction Low levels of low-density lipoprotein (LDL) have been suggested to increase the risk of hemorrhagic transformation following acute ischemic stroke (AIS). However, the literature on the relationship between LDL levels and post-thrombectomy hemorrhagic complications is sparse. The aim of this study is to investigate the association between LDL level and delayed parenchymal hematoma (PH) following endovascular treatment for AIS.
Materials and Methods Upon obtaining institutional review board approval, we conducted a retrospective analysis of all patients with large vessel occlusion ischemic stroke who underwent thrombectomy at a comprehensive stroke center from 2018-2021. All patients received dual-energy head CT (DEHCT) immediately post-thrombectomy and MRI or CT at 24 hours as routine standard of care. The presence of contrast and/or hemorrhage was assessed by iodine map and virtual non-contrast images of DEHCT. Delayed PH was determined by 24-hour imaging. Patients with hemorrhage on DEHCT were excluded. For univariate analysis, chi-squared and Mann-Whitney tests were performed for categorical and continuous variables, respectively. We then performed multivariate logistic regression using stepwise backward elimination to determine independent predictors of delayed PH.
Results A total of 160 patients without hemorrhage on post-thrombectomy DEHCT were included in the analysis. Among them, 18 patients (11%) developed delayed PH on 24-hour imaging. On univariate analysis, delayed PH was associated with lower LDL level (75.83 mg/dL vs. 94.78 mg/dL, p=0.040), lower high-density lipoprotein level (35.94 mg/dL vs. 42.86 mg/dL, p=0.048), higher presenting NIHSS (20.00 vs. 14.80, p=0.0194), higher contrast volume (55.51 mL vs. 9.07 mL, p<0.001), higher mean contrast density (27.60 HU vs. 13.81 HU, p<0.001), larger standard deviation of contrast density (11.36 HU vs. 4.75 HU, p<0.001), and higher maximum contrast density (100.33 HU vs. 38.89 HU, p<0.001). Statin use and triglyceride level were not associated.
In the multivariate logistic regression model, contrast volume (OR:1.05, 95% CI:1.02-1.0877, p=0.0035, per 1 mL increase) and LDL level (OR:0.95, 95% CI:0.92-0.99, p=0.01, per 1 mg/dL increase) were associated with delayed PH following thrombectomy. After adjusting for potential confounders, LDL<50 mg/dL (OR:5.38, 95% CI:1.70-17.04, p=0.004) was an independent predictor of delayed PH, while LDL >100 mg/dL (OR:0.26, 95% CI:0.07-0.96, p=0.041) was a protective factor.
Conclusion LDL level <50 mg/dL independently predicted delayed PH following thrombectomy and LDL >100 was shown to be a protective factor, irrespective of statin use. Further study is needed to explore the underlying mechanism and identify the strategies to prevent post-thrombectomy delayed PH among patients with low LDL levels.
Disclosures S. Ahn: None. S. Roth: None. J. Jo: None. Y. Ko: None. N. Mummareddy: None. M. Fusco: None. R. Chitale: None. M. Froehler: None.
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