Association of Alkaline Phosphatase Level with Futile Recanalization in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy.

Milan Jia, Wantong Yu, Feiyang Jin, Jiali Xu, Wenting Guo, Mengke Zhang, Sijie Li, Changhong Ren, Yuchuan Ding, Wenbo Zhao, Jing Lan, Xunming Ji
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Abstract

Objective: Nearly half of Acute Ischemic Stroke (AIS) patients failed to achieve favorable outcomes despite successful reperfusion treatment. This phenomenon is referred to as Futile Recanalization (FR). Screening patients at risk of FR is vital for stroke management. Previous studies reported the diagnostic value of alkaline phosphatase (ALP) levels in certain aspects of stroke prognosis. However, the association between serum ALP level and FR among AIS patients treated with thrombectomy remained unclear.

Methods: We screened stroke patients who underwent thrombectomy at our center from January 2017 to June 2021, and those who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score=3) were ultimately analyzed. Demographic information, vascular risk factors, and laboratory test results were collected at admission. The 3-month unfavorable outcome was defined as a modified Rankin Scale score of 3 to 6. The effect of ALP levels on FR was investigated with a logistic regression model.

Results: Of 788 patients who underwent thrombectomy, 277 achieved successful reperfusion. Among them, 142 patients (51.3%) failed to realize favorable outcomes at 3 months. After adjusting for confounding variables, higher ALP levels (p =0.002) at admission were independently associated with unfavorable outcomes at three months. Adding ALP values to conventional risk factors improved the performance of prediction models for FR.

Conclusion: The current study found that the serum ALP levels at admission emerged as a potential biomarker for futile reperfusion in stroke patients undergoing thrombectomy. Further studies are warranted to confirm the clinical applicability of ALP level for futile recanalization prediction.

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使用血管内血栓切除术治疗的急性缺血性脑卒中患者体内碱性磷酸酶水平与再通术失败率的关系
目的:近一半的急性缺血性脑卒中(AIS)患者尽管接受了成功的再灌注治疗,但仍无法获得良好的预后。这种现象被称为徒劳再灌注(FR)。筛查有 FR 风险的患者对卒中治疗至关重要。之前的研究报道了碱性磷酸酶(ALP)水平对卒中预后某些方面的诊断价值。然而,在接受血栓切除术治疗的 AIS 患者中,血清 ALP 水平与 FR 之间的关系仍不明确:我们筛选了 2017 年 1 月至 2021 年 6 月在本中心接受血栓切除术的脑卒中患者,最终分析了成功再灌注(改良脑梗死溶栓评分=3)的患者。入院时收集了人口统计学信息、血管风险因素和实验室检查结果。3个月的不良预后定义为改良Rankin量表评分3至6分。通过逻辑回归模型研究了ALP水平对FR的影响:结果:在接受血栓切除术的 788 例患者中,277 例成功实现了再灌注。其中,142 名患者(51.3%)在 3 个月后未能获得良好的治疗效果。在对混杂变量进行调整后,入院时较高的 ALP 水平(p =0.002)与三个月后的不良预后独立相关。在常规风险因素中加入 ALP 值可提高 FR 预测模型的性能:本研究发现,入院时的血清 ALP 水平是接受血栓切除术的卒中患者进行无效再灌注的潜在生物标志物。为了证实 ALP 水平对无效再灌注预测的临床适用性,还需要进一步研究。
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