Highlights
- •ASITN/SIR scoring of the intracranial collateral circulation was performed in all patients by the gold standard DSA technique.
- •Neutrophil/lymphocyte ratio (NLR) may be associated with collateral circulation through inflammatory response and atherosclerosis.
- •We suggest that NLR levels correlate with the development of cerebral collateral circulation in patients with symptomatic severe stenosis or occlusion of intracranial arteries.
Abstract
Background
The neutrophil/lymphocyte ratio (NLR) has been considered a prognostic indicator for
determining the systemic inflammatory response and atherosclerosis. We aimed to determine
the relationship between NLR and the development of cerebral collateral circulation
in patients with symptomatic severe stenosis or occlusion of intracranial arteries.
Methods
All patients underwent digital subtraction angiography (DSA) within 14 days of admission
and were divided into a group with good collateral circulation (77 patients) and a
group with poor collateral circulation (86 patients) according to the DSA collateral
compensation grading method. Apo B, total cholesterol, LDL, and Neutrophil count in
the poor side branch group were significantly higher than in the good side branch
group. Multifactorial analysis showed that high NLR levels were a valid predictor
of poor collateral circulation in patients with symptomatic severe intracranial artery
stenosis or occlusion. Spearman correlation analysis showed that the size of the collateral
branch score was negatively correlated with NLR (r = −0.509, P < 0.001) and cholesterol
content (r = −0.249, P = 0.002). NLR predicted poor collateral circulation with an
AUC of 0.620 (sensitivity 66.7 %, specificity 61.3 %, 95 % CI = 0.517–0.723,P < 0.05).
Conclusion
We demonstrate a correlation between NLR levels and the development of collateral
circulation in the brain in patients with symptomatic severe stenosis or occlusion
of the intracranial arteries.
Keywords
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References
- Atherosclerosis Is an Inflammatory Disease which Lacks a Common Anti-inflammatory Therapy: How Human Genetics Can Help to This Issue. A Narrative Review.Front Pharmacol. 2018; 9: 55
- Neutrophil to lymphocyte ratio predicts intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke.J Neuroinflammation. 2018; 15: 319
- Neutrophils and neutrophil-lymphocyte ratio: Inflammatory markers associated with intimal-media thickness of atherosclerosis.Thromb Res. 2018; 170: 45-52
- Can the Neutrophil-to-Lymphocyte Ratio Appropriately Predict Carotid Artery Stenosis in Patients with Ischemic Stroke?-A Retrospective Study.J Stroke Cerebrovasc Dis. 2015; 24: 2646-2651
- A high neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation of large atherosclerotic infarction in patients with acute ischemic stroke.Aging (Albany NY). 2020; 12: 2428-2439
- High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia.Stroke. 2018; 49: 1886-1892
- Global burden of intracranial atherosclerosis.Int J Stroke. 2006; 1: 158-159
- Collaterals dramatically alter stroke risk in intracranial atherosclerosis.Ann Neurol. 2011; 69: 963-974
- Induction of cerebral arteriogenesis leads to early-phase expression of protease inhibitors in growing collaterals of the brain.J Cereb Blood Flow Metab. 2008; 28: 1811-1823
- Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment.Lancet Neurol. 2022; 21: 355-368
- Prevalence, predictors, and prognosis of symptomatic intracranial stenosis in patients with transient ischaemic attack or minor stroke: a population-based cohort study.Lancet Neurol. 2020; 19: 413-421
- Inter- and intraobserver reliability for angiographic leptomeningeal collateral flow assessment by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale.J Neurointerv Surg. 2019; 11: 338-341
- Chronic cerebral hypoperfusion induces vascular plasticity and hemodynamics but also neuronal degeneration and cognitive impairment.J Cereb Blood Flow Metab. 2015; 35: 1249-1259
- Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial.JAMA. 2011; 306: 1983-1992
- Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.JAMA. 1998; 280: 1055-1060
- Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis.J Magn Reson Imaging. 2020; 51: 195-204
- DSC perfusion-based collateral imaging and quantitative T2 mapping to assess regional recruitment of leptomeningeal collaterals and microstructural cortical tissue damage in unilateral steno-occlusive vasculopathy.J Cereb Blood Flow Metab. 2021; 41: 67-81
- Blood Flow Lateralization and Collateral Compensatory Mechanisms in Patients With Carotid Artery Stenosis.Stroke. 2019; 50: 1081-1088
- Vascular Morphology has No Direct Relationship with Atherosclerotic Plaque Burden in Patients with Symptomatic Middle Cerebral Artery Stenosis.Curr Neurovasc Res. 2019; 16: 224-231
- Relationship of mean platelet volume to lymphocyte ratio and coronary collateral circulation in patients with stable angina pectoris.Coron Artery Dis. 2017; 28: 492-497
- Safety of Endovascular Therapy in Progressive Ischemic Stroke and Anterior Circulation Large Artery Occlusion.World Neurosurg. 2019; 122: 383-389
- Janus phenomenon: the interrelated tradeoffs inherent in therapies designed to enhance collateral formation and those designed to inhibit atherogenesis.Circulation. 2004; 109: 2826-2831
- Relation between carotid vulnerable plaques and peripheral leukocyte: a case-control study of comparison utilizing multi-parametric contrast-enhanced ultrasound.BMC Med Imaging. 2019; 19: 74
- Leukocytes, Collateral Circulation, and Reperfusion in Ischemic Stroke Patients Treated With Mechanical Thrombectomy.Stroke. 2019; 50: 3456-3464
- Postischemic revascularization: from cellular and molecular mechanisms to clinical applications.Physiol Rev. 2013; 93: 1743-1802
- Regulation of leucocyte homeostasis in the circulation.Cardiovasc Res. 2015; 107: 340-351
- Neutrophil Count as a Predictor of Critical Coronary Artery Stenosis in Young Patients.Iran J Public Health. 2018; 47: 765-767
- Elevated Neutrophil and Presence of Intracranial Artery Stenosis Increase the Risk of Recurrent Stroke.Stroke. 2018; 49: 2294-2300
- Associations of the neutrophil to lymphocyte ratio with intracranial artery stenosis and ischemic stroke.BMC Neurol. 2021; 21: 56
- The pathway of neutrophil extracellular traps towards atherosclerosis and thrombosis.Atherosclerosis. 2019; 288: 9-16
- Neutrophil to lymphocyte ratio and risk of a first episode of stroke in patients with atrial fibrillation: a cohort study.J Thromb Haemost. 2015; 13: 1971-1979
- Neutrophil Extracellular Traps and Endothelial Dysfunction in Atherosclerosis and Thrombosis.Front Immunol. 2017; 8: 928
- Levels of anti-inflammatory cytokines and neurological worsening in acute ischemic stroke.Stroke. 2003; 34: 671-675
- B-cell aortic homing and atheroprotection depend on Id3.Circ Res. 2012; 110: e1-e
- Ratio of neutrophil to lymphocyte counts–rapid and simple parameter of systemic inflammation and stress in critically ill.Bratisl Lek Listy. 2001; 102: 5-14
- Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis.J Stroke Cerebrovasc Dis. 2016; 25: 578-584
- Risk factors for intracranial atherosclerosis: A systematic review and meta-analysis.Atherosclerosis. 2019; 281: 71-77
- Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes.Lancet. 2014; 383: 1973-1980
- Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin Chronic Low-Grade Systemic Inflammation and Health cohort study.Eur J Endocrinol. 2015; 173: 217-225
- Neutrophil to lymphocyte ratio as predictor for incident hypertension: a 9-year cohort study in Taiwan.Hypertens Res. 2019; 42: 1209-1214
- Clinical pertinence of neutrophil-to- lymphocyte ratio among hypertensives with different grades and duration of hypertension - an insight.Clin Exp Hypertens. 2019; 41: 394-399
- The associations between neutrophil-to-lymphocyte ratio and the Chinese Visceral Adiposity Index, and carotid atherosclerosis and atherosclerotic cardiovascular disease risk.Exp Gerontol. 2020; 139
Article info
Publication history
Accepted:
October 24,
2022
Received:
June 8,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
