Early plasma YKL40 level is associated with 3-month functional outcome in ischemic stroke patients treated with endovascular therapy

Introduction

More than 40% of large vessel occlusion ischemic stroke patients remain disabled at 3 months despite successful reperfusion therapies including intravenous thrombolysis and endovascular therapy (EVT). This neurological disability is mainly due to sensori-motor sequelae and post-stroke cognitive impairment (PSCI). Glycoprotein YKL40 is a biomarker of astrocytic and microglial activation. It is elevated in plasma in numerous neurodegenerative disorders but also in acute ischemic stroke. We hypothesized that acute microglial inflammation plays a key role in PSCI and that plasma levels of YKL40 in acute stroke could be a predictive biomarker of future cognitive and functional outcomes.

Methods

Monocentric prospective study included patients treated with EVT, for whom 3 blood samples (before, within 1 h, 24 h post-EVT) were drawn to measure plasma YKL40 concentrationas a marker of microglial activation. Excellent outcome was defined as a modified Rankin scale (mRS) between 0–1 at 3 months.

Results

We included 120 patients between 2016–2020. Median NIHSS was 17 and median ASPECT score was 7. Reperfusion was achieved at a mean delay of 5 h 44. After three months, median mRS was 3 and 25% of patients with pre-stroke mRS < 2 had excellent outcome.

Excellent clinical outcome was significantly associated with plasma YKL40 levels (P = 0.001) after adjustment on age, NIHSS and delay since onset.

Discussion

Plasma YKL40 is a candidate predictor of the functional outcome at 3 months in ischemic stroke treated by EVT. This novel biomarker of stroke could allow optimizing rehabilitation after a stroke and give new insight on pathophysiology of PSCI.