Usefulness of ADAMTS13 to predict response to recanalization therapies in acute ischemic stroke
| Autor: | Carlos A. Molina, Alba Simats, Teresa García-Berrocoso, Anna Penalba, Marc Ribó, Jorge Pagola, Joan Montaner, Cristina Boada, Alejandro Bustamante, Eng H. Lo, MingMing Ning |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry Odds ratio 030204 cardiovascular system & hematology medicine.disease Logistic regression Tissue plasminogen activator Article ADAMTS13 Transcranial Doppler 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale hemic and lymphatic diseases Internal medicine Diabetes mellitus medicine Cardiology Neurology (clinical) Prospective cohort study business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Neurology. 90:e995-e1004 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000005162 |
| Popis: | ObjectiveWe aimed to analyze ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) in relation to arterial recanalization in patients treated with IV tissue plasminogen activator (tPA) and in relation to futile recanalization in patients treated with mechanical thrombectomy.MethodsAcute ischemic stroke patients (n = 108) with documented arterial occlusions treated with IV-tPA were selected. ADAMTS13 activity was measured by ELISA in samples collected before treatment. Recanalization was assessed at 2 hours by transcranial Doppler. In 78 consecutive patients treated with endovascular thrombectomy, ADAMTS13 antigen was measured by ELISA and futile recanalization was defined as complete recanalization plus modified Rankin Scale score >2 at 3 months. Independent predictors of recanalization and futile recanalization were determined by logistic regression, adjusted by age, NIH Stroke Scale score, and time from stroke onset.ResultsPatients who achieved tPA-induced recanalization had higher baseline ADAMTS13 activity (78.1% [68%–88%] vs 70.1% [61%–79%], p = 0.021). In logistic regression analysis, ADAMTS13 activity >75% was an independent predictor of recanalization (odds ratio = 6.76 [1.52–30.02], p = 0.012), together with absence of early ischemic signs and Oxfordshire Community Stroke Project classification. Regarding endovascular therapies, a reduced ADAMTS13 concentration (p = 0.034), together with age and diabetes mellitus. The addition of ADAMTS13 to clinical predictors of tPA-induced recanalization and futile recanalization improved discrimination and reclassification (integrated discrimination improvement = 10.06% and 28.4%, net reclassification improvement = 61.0% and 107.4%, respectively).ConclusionsA reduced ADAMTS13 was associated with poor response to recanalization therapies. If confirmed in future prospective studies, a panel of blood biomarkers including ADAMTS13 might be a useful tool to guide reperfusion therapies. |
| Databáze: | OpenAIRE |
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