Introduction: Despite the usefulness of mechanical thrombectomy (MT), around 50% of the patients had poor outcome after achievement of complete recanalization. We aimed to test blood biomarkers to predict futile recanalization (FR) in patients treated with MT.
Methods: Consecutive stroke patients were enrolled from August-2012 to August-2014. Blood samples were collected at admission. Biomarkers were selected among pathophysiological pathways related to FR: inflammation (VCAM-1), thrombosis (ADAMTS13), lipid metabolism (ApoC-III). FR was defined as complete recanalization after endovascular procedure (TICI 2b-3) and poor functional outcome (mRS>2) at three months. Comparisons were performed between patients with futile and successful recanalization. Independent predictors of FR were determined by logistic regression. The additional predictive value of blood biomarkers was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indexes, considering thresholds of 25-75% risk categories for the later.
Results: From 87 patients treated with MT, 73 were included. Complete recanalization was achieved in 58 patients, being futile in 33 patients (57%). Patients with FR had a trend towards lower levels of both ADAMTS13 and ApoC-III. The rate of FR when both biomarkers were under the 1st quartile was 100%. Both biomarkers were independent predictors of FR in logistic regression analysis [ADAMTS13; OR=8.01 (1.20-53.5), p=0.032. ApoC-III; OR=6.94 (1.32-36.62), p=0.022], together with previous mRS [OR=5.75 (1.73-19.05), p=0.004] and diabetes [OR=7.6 (1.26-45.1), p=0.032]. The addition of both biomarkers improved discrimination [IDI=13.8% (4.7-22.9), p=0.003], and reclassification [60.2% (31.4-89.1), p<0.0001]).
Conclusions: Pre-treatment levels of ADAMTS13 and ApoC-III are predictors of FR. These blood markers might be used to guide reperfusion therapies.