Skip to content
2000
image of Association of Alkaline Phosphatase Level with Futile Recanalization in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy

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 ( =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.

Loading

Article metrics loading...

/content/journals/cnr/10.2174/0115672026344020240911114809
2024-10-03
2025-01-23
Loading full text...

Full text loading...

References

  1. Powers W.J. Rabinstein A.A. Ackerson T. Adeoye O.M. Bambakidis N.C. Becker K. Biller J. Brown M. Demaerschalk B.M. Hoh B. Jauch E.C. Kidwell C.S. Leslie-Mazwi T.M. Ovbiagele B. Scott P.A. Sheth K.N. Southerland A.M. Summers D.V. Tirschwell D.L. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019 50 12 e344 e418 10.1161/STR.0000000000000211 31662037
    [Google Scholar]
  2. Wu C. Yang N. Lee H. Intravenous thrombolysis for acute ischemic stroke: From alteplase to tenecteplase. Brain Circ. 2023 9 2 61 63 10.4103/bc.bc_70_22 37576574
    [Google Scholar]
  3. Suzuki K. Matsumaru Y. Takeuchi M. Morimoto M. Kanazawa R. Takayama Y. Kamiya Y. Shigeta K. Okubo S. Hayakawa M. Ishii N. Koguchi Y. Takigawa T. Inoue M. Naito H. Ota T. Hirano T. Kato N. Ueda T. Iguchi Y. Akaji K. Tsuruta W. Miki K. Fujimoto S. Higashida T. Iwasaki M. Aoki J. Nishiyama Y. Otsuka T. Kimura K. Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke. JAMA 2021 325 3 244 253 10.1001/jama.2020.23522 33464334
    [Google Scholar]
  4. Nie X. Leng X. Miao Z. Fisher M. Liu L. Clinically Ineffective Reperfusion After Endovascular Therapy in Acute Ischemic Stroke. Stroke 2023 54 3 873 881 10.1161/STROKEAHA.122.038466 36475464
    [Google Scholar]
  5. Kan Y. Li S. Zhang B. Ding Y. Zhao W. Ji X. No-reflow phenomenon following stroke recanalization therapy: Clinical assessment advances: A narrative review. Brain Circ. 2023 9 4 214 221 10.4103/bc.bc_37_23 38284109
    [Google Scholar]
  6. Feng Y. Bai X. Li W. Cao W. Xu X. Yu F. Fu Z. Tian Q. Guo X. Wang T. Sha A. Chen Y. Gao P. Wang Y. Chen J. Ma Y. Chen F. Dmytriw A.A. Regenhardt R.W. Lu J. Ma Q. Yang B. Jiao L. Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy. Front. Immunol. 2022 13 963111 10.3389/fimmu.2022.963111 36275640
    [Google Scholar]
  7. Chaurasia R.N. Dash P. Singh V.K. Gautam D. Pathak A. Kumar A. Mishra S.P. Dash D. Mishra V.N. Joshi D. Aspirin resistance and blood biomarkers in predicting ischemic stroke recurrence: An exploratory study. Brain Circ. 2022 8 1 31 37 10.4103/bc.bc_75_21 35372727
    [Google Scholar]
  8. Hervella P. Sampedro-Viana A. Rodríguez-Yáñez M. López-Dequidt I. Pumar J.M. Mosqueira A.J. Fernández-Rodicio S. Bazarra-Barreiros M. Serena J. Silva-Blas Y. Gubern-Merida C. Rey-Aldana D. Cinza S. Campos F. Sobrino T. Castillo J. Alonso-Alonso M.L. Iglesias-Rey R. Systemic biomarker associated with poor outcome after futile reperfusion. Eur. J. Clin. Invest. 2024 54 6 e14181 10.1111/eci.14181 38361320
    [Google Scholar]
  9. Haarhaus M. Brandenburg V. Kalantar-Zadeh K. Stenvinkel P. Magnusson P. Alkaline phosphatase: A novel treatment target for cardiovascular disease in CKD. Nat. Rev. Nephrol. 2017 13 7 429 442 10.1038/nrneph.2017.60 28502983
    [Google Scholar]
  10. Jiang C. Hu F. Li J. Gao G. Guo X. Diagnostic value of alkaline phosphatase and bone-specific alkaline phosphatase for metastases in breast cancer: A systematic review and meta-analysis. Breast Cancer Res. Treat. 2023 202 2 233 244 10.1007/s10549‑023‑07066‑z 37522998
    [Google Scholar]
  11. Makris K. Mousa C. Cavalier E. Alkaline Phosphatases: Biochemistry, Functions, and Measurement. Calcif. Tissue Int. 2022 112 2 233 242 10.1007/s00223‑022‑01048‑x 36571614
    [Google Scholar]
  12. Haarhaus M. Cianciolo G. Barbuto S. La Manna G. Gasperoni L. Tripepi G. Plebani M. Fusaro M. Magnusson P. Alkaline Phosphatase: An Old Friend as Treatment Target for Cardiovascular and Mineral Bone Disorders in Chronic Kidney Disease. Nutrients 2022 14 10 2124 10.3390/nu14102124 35631265
    [Google Scholar]
  13. Mori K. Janisch F. Parizi M.K. Mostafaei H. Lysenko I. Enikeev D.V. Kimura S. Egawa S. Shariat S.F. Prognostic value of alkaline phosphatase in hormone-sensitive prostate cancer: A systematic review and meta-analysis. Int. J. Clin. Oncol. 2020 25 2 247 257 10.1007/s10147‑019‑01578‑9 31768692
    [Google Scholar]
  14. Ma J. Guo W. Xu J. Li S. Ren C. Wu L. Wu C. Li C. Chen J. Duan J. Ma Q. Song H. Zhao W. Ji X. Association of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with outcomes in stroke patients achieving successful recanalization by endovascular thrombectomy. Front. Neurol. 2022 13 1039060 10.3389/fneur.2022.1039060 36588905
    [Google Scholar]
  15. Yan W. Yan M. Wang H. Xu Z. Associations of serum alkaline phosphatase level with all-cause and cardiovascular mortality in the general population. Front. Endocrinol. (Lausanne) 2023 14 1217369 10.3389/fendo.2023.1217369 37867513
    [Google Scholar]
  16. Zong L. Wang X. Li Z. Zhao X. Liu L. Li H. Meng X. Wang Y. Wang Y. Alkaline Phosphatase and Outcomes in Patients With Preserved Renal Function. Stroke 2018 49 5 1176 1182 10.1161/STROKEAHA.118.020237 29669879
    [Google Scholar]
  17. Tyagi K. Venkatesh V. Emerging potential approaches in alkaline phosphatase (ALP) activatable cancer theranostics. RSC Med. Chem. 2024 15 4 1148 1160 10.1039/D3MD00565H 38665831
    [Google Scholar]
  18. Kabootari M. Raee M.R. Akbarpour S. Asgari S. Azizi F. Hadaegh F. Serum alkaline phosphatase and the risk of coronary heart disease, stroke and all-cause mortality: Tehran Lipid and Glucose Study. BMJ Open 2018 8 11 e023735 10.1136/bmjopen‑2018‑023735 30478120
    [Google Scholar]
  19. Park J.B. Kang D. Yang H.M. Cho H.J. Park K.W. Lee H.Y. Kang H.J. Koo B.K. Kim H.S. Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug-eluting stent. Eur. Heart J. 2013 34 12 920 931 10.1093/eurheartj/ehs419 23242189
    [Google Scholar]
  20. Shimizu Y. Imano H. Ohira T. Kitamura A. Kiyama M. Okada T. Ishikawa Y. Shimamoto T. Yamagishi K. Tanigawa T. Iso H. Alkaline phosphatase and risk of stroke among Japanese: The Circulatory Risk in Communities Study (CIRCS). J. Stroke Cerebrovasc. Dis. 2013 22 7 1046 1055 10.1016/j.jstrokecerebrovasdis.2012.06.009 22841505
    [Google Scholar]
  21. Liu K. Yu Y. Yuan Y. Xu X. Lei W. Niu R. Shen M. Zhou L. Peng R. Wang Q. Yang H. Guo H. Ge Y. Liu G. He M. Wu T. Zhang X. Elevated Levels of Serum Alkaline Phosphatase are Associated with Increased Risk of Cardiovascular Disease: A Prospective Cohort Study. J. Atheroscler. Thromb. 2023 30 7 795 819 10.5551/jat.63646 36261365
    [Google Scholar]
  22. Kim J. Song T.J. Song D. Lee H.S. Nam C.M. Nam H.S. Kim Y.D. Heo J.H. Serum alkaline phosphatase and phosphate in cerebral atherosclerosis and functional outcomes after cerebral infarction. Stroke 2013 44 12 3547 3549 10.1161/STROKEAHA.113.002959 24021686
    [Google Scholar]
  23. Guo W. Liu Z. Lu Q. Liu P. Lin X. Wang J. Wang Y. Chang Q. Wang F. Wu S. Non-Linear Association Between Serum Alkaline Phosphatase and 3-Month Outcomes in Patients With Acute Stroke: Results From the Xi’an Stroke Registry Study of China. Front. Neurol. 2022 13 859258 10.3389/fneur.2022.859258 35911898
    [Google Scholar]
  24. Li S. Wang W. Zhang Q. Wang Y. Wang A. Zhao X. Association Between Alkaline Phosphatase and Clinical Outcomes in Patients With Spontaneous Intracerebral Hemorrhage. Front. Neurol. 2021 12 677696 10.3389/fneur.2021.677696 34526953
    [Google Scholar]
  25. Tao X. Yang C. He J. Liu Q. Wu S. Tang W. Wang J. Serum alkaline phosphatase was independently associated with depression in patients with cerebrovascular disease. Front. Psychiatry 2023 14 1184673 10.3389/fpsyt.2023.1184673 37469359
    [Google Scholar]
  26. Ryu W.S. Lee S.H. Kim C.K. Kim B.J. Yoon B.W. Increased serum alkaline phosphatase as a predictor of long-term mortality after stroke. Neurology 2010 75 22 1995 2002 10.1212/WNL.0b013e3181ff966a 21115954
    [Google Scholar]
  27. Wang Z. Li J. Jing J. Zhang Z. Xu Q. Liu T. Lin J. Jiang Y. Wang Y. Wang A. Meng X. Impact of alkaline phosphatase on clinical outcomes in patients with ischemic stroke: A nationwide registry analysis. Front. Neurol. 2024 15 1336069 10.3389/fneur.2024.1336069 38419697
    [Google Scholar]
  28. Zhu H.J. Sun X. Guo Z.N. Qu Y. Sun Y.Y. Jin H. Wang M.Q. Xu B.F. Yang Y. Prognostic values of serum alkaline phosphatase and globulin levels in patients undergoing intravenous thrombolysis. Front. Mol. Neurosci. 2022 15 932075 10.3389/fnmol.2022.932075 35909453
    [Google Scholar]
  29. Lomashvili K.A. Narisawa S. Millán J.L. O’Neill W.C. Vascular calcification is dependent on plasma levels of pyrophosphate. Kidney Int. 2014 85 6 1351 1356 10.1038/ki.2013.521 24717293
    [Google Scholar]
  30. Bessueille L. Kawtharany L. Quillard T. Goettsch C. Briolay A. Taraconat N. Balayssac S. Gilard V. Mebarek S. Peyruchaud O. Duboeuf F. Bouillot C. Pinkerton A. Mechtouff L. Buchet R. Hamade E. Zibara K. Fonta C. Canet-soulas E. Millan J. Magne D. Inhibition of alkaline phosphatase impairs dyslipidemia and protects mice from atherosclerosis. Transl. Res. 2023 251 2 13 10.1016/j.trsl.2022.06.010 35724933
    [Google Scholar]
  31. Du H. Zheng J. Li X. Bos D. Yang W. Cheng Y. Liu C. Wong L.K.S. Hu J. Chen X. The correlation between intracranial arterial calcification and the outcome of reperfusion therapy. Ann. Clin. Transl. Neurol. 2023 10 6 974 982 10.1002/acn3.51780 37088543
    [Google Scholar]
  32. Yu Y. Zhang F.L. Qu Y.M. Zhang P. Zhou H.W. Luo Y. Wang Y. Liu J. Qin H.Q. Guo Z.N. Yang Y. Intracranial Calcification is Predictive for Hemorrhagic Transformation and Prognosis After Intravenous Thrombolysis in Non-Cardioembolic Stroke Patients. J. Atheroscler. Thromb. 2021 28 4 356 364 10.5551/jat.55889 32595195
    [Google Scholar]
  33. Ryu W.S. Lee S.H. Kim C.K. Kim B.J. Kwon H.M. Yoon B.W. High serum alkaline phosphatase in relation to cerebral small vessel disease. Atherosclerosis 2014 232 2 313 318 10.1016/j.atherosclerosis.2013.11.047 24468144
    [Google Scholar]
  34. Mechtouff L. Bochaton T. Paccalet A. Da Silva C.C. Buisson M. Amaz C. Derex L. Ong E. Berthezene Y. Eker O.F. Dufay N. Mewton N. Ovize M. Cho T.H. Nighoghossian N. Association of Interleukin-6 Levels and Futile Reperfusion After Mechanical Thrombectomy. Neurology 2021 96 5 e752 e757 10.1212/WNL.0000000000011268 33262232
    [Google Scholar]
  35. Nwafor D.C. Brichacek A.L. Ali A. Brown C.M. Tissue-Nonspecific Alkaline Phosphatase in Central Nervous System Health and Disease: A Focus on Brain Microvascular Endothelial Cells. Int. J. Mol. Sci. 2021 22 10 5257 10.3390/ijms22105257 34067629
    [Google Scholar]
  36. Sperring C.P. Savage W.M. Argenziano M.G. Leifer V.P. Alexander J. Echlov N. Spinazzi E.F. Connolly E.S. Jr No-Reflow Post-Recanalization in Acute Ischemic Stroke: Mechanisms, Measurements, and Molecular Markers. Stroke 2023 54 9 2472 2480 10.1161/STROKEAHA.123.044240 37534511
    [Google Scholar]
  37. Pedraza M.I. de Lera M. Bos D. Calleja A.I. Cortijo E. Gómez-Vicente B. Reyes J. Coco-Martín M.B. Calonge T. Agulla J. Martínez-Pías E. Talavera B. Pérez-Fernández S. Schüller M. Galván J. Castaño M. Martínez-Galdámez M. Arenillas J.F. Brain Atrophy and the Risk of Futile Endovascular Reperfusion in Acute Ischemic Stroke. Stroke 2020 51 5 1514 1521 10.1161/STROKEAHA.119.028511 32188368
    [Google Scholar]
/content/journals/cnr/10.2174/0115672026344020240911114809
Loading
/content/journals/cnr/10.2174/0115672026344020240911114809
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test