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Acute astrocytic reaction is associated with 3-month functional outcome after stroke treated with endovascular therapy

April 2024

Ada Boutelier, Véronique Ollivier, Mikael Mazighi, Maeva Kyheng, Julien Labreuche, Nahida Brikci-Nigassa, Mialitiana Solo Nomenjanahary, Francois Delvoye, Benjamin Maier, Claire Paquet, Benoit Ho-Tin-Noe and Jean-Philippe Desilles; on behalf of the NeutroStroke Study Group

Introduction: More than 50% of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with
endovascular therapy (EVT) remain severely disabled at 3 months. We hypothesized that acute astrocytic inflammatory
response may play a pivotal role in post-AIS brain changes associated with poor functional outcome. We proposed to
evaluate the level of YKL-40, a glycoprotein mainly released by reactive astrocytes.
Patients and methods: A monocentric prospective cohort study was conducted on consecutive LVO AIS patients
treated with EVT. Three blood samples (before, within 1 and 24-hour post-EVT) were collected to measure plasma YKL-
40 concentrations. Functional outcome was assessed according to the modified Rankin Scale (mRS) score at 3 months.
Results: Between 2016 and 2020, 120 patients were included. The plasma concentration of YKL-40 before EVT was
statistically and independently associated with 3-month worse functional outcome (adjusted cOR, 1.59; 95% CI [1.05–
2.44], p = 0.027) but not the two following samples 1-hour and 24-hour post-EVT. Accordingly, we found that excellent
functional outcome was associated with a lower level of YKL-40 before and within 1 h after EVT (p = 0.005 and p = 0.003,
respectively) but not when measured 24 h after EVT (p = 0.2).
Discussion and conclusion: This study suggests that the astrocytic reaction to acute brain hypoxia, especially before
recanalization, is associated with worse functional outcome. Such early biomarker of the astrocytic response in AIS may
optimize individualized care in the future.