Abstract Body: Background: Mechanical thrombectomy has been associated with improved outcomes in patients with acute ischemic stroke. However, not all patients with successful reperfusion experience good functional outcomes. Investigating the post-reperfusion inflammatory milieu could provide valuable insights into the mechanisms that influence stroke outcomes. We hypothesized that successful reperfusion may cause distinct cytokine/ chemokine profiles.
Methods: Plasma samples were collected from patients with ischemic stroke that were admitted to Memorial Hermann Hospital, Houston within 24 hours of admission. Multiplex was used to analyze the plasma samples for levels of 48 cytokines and chemokines. The relationship between thrombectomy (TICI 2b and above) and analytes was assessed using ANOVA and then adjusted association was examined using multilinear regression models after adjusting for patient demographics and comorbidities.
Results: The mean age of patients was 63.3 years, 54% were women, 87% had hypertension, 44% had diabetes mellitus, and 54% had hyperlipidemia. Only two out of the 48 cytokines demonstrated differences with thrombectomy. CCL4 levels were significantly higher in patients that underwent thrombectomy, 55.7±17.4 pg/ml vs. 39.5±20.6 pg/ml in the ones that did not undergo this procedure, p=0.01. Similarly, CCL-5 (RANTES) levels were elevated in patients with acute ischemic stroke that underwent thrombectomy 368.6±275.1 vs. others, 216.5±156.3, p=0.01. These remained significant after adjusting for co-morbidities.
Conclusions: Our study suggests that MIP-1β (CCL4) and RANTES (CCL5) are significantly elevated in ischemic stroke patients that underwent successful reperfusion by mechanical thrombectomy. CCL4 or MIP-1β (macrophage inflammatory protein -1) is a chemoattractant for monocytes in injured tissue. CCL5 or RANTES (regulated on activation, normal T-cell expressed and secreted) is also a chemokine secreted by T cells and monocytes and directly interacts with CCL4. CCL4 and CCL5 may contribute to the post-ischemia reperfusion inflammatory response, potentially influencing outcomes after reperfusion therapies such as mechanical thrombectomy. Longitudinal analysis of these chemokines and other cytokines after mechanical thrombectomy, along with their correlation with functional outcomes may provide deeper insights into the underlying mechanisms and also identify potential biomarkers of successful mechanical thrombectomy in stroke patients.