Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Plasma Homocysteine and Prognosis of Patients with Recanalization after Acute Basilar Artery Occlusion: An Analysis from the Acute Basilar Artery Occlusion Study (BASILAR) Nationwide Prospective Registry

Author(s): Xiangrong Sun, Qian Yang, Xinyue Ju, Shenglin Wang, Zhongming Qiu, Hongfei Sang, Wenjie Zi, Qingwu Yang and Guohui Jiang*

Volume 18, Issue 2, 2021

Published on: 08 July, 2021

Page: [197 - 203] Pages: 7

DOI: 10.2174/1567202618666210708102502

Price: $65

Abstract

Background: Few studies have investigated the association between plasma Homocysteine (Hcy) levels in patients with recanalization after acute Basilar Artery Occlusion (BAO).

Objective: This study investigated the predictive value of Hcy on the clinical prognosis of patients with recanalization after acute BAO.

Methods: Altogether, 829 participants were recruited from the standard medical treatment plus endovascular treatment group of the Acute Basilar Artery Occlusion Study (BASILAR). Hcy levels were measured the morning after admission. The primary outcome was a combination of death and major disability (modified Rankin Scale score 4-6) at 90 days, and the secondary outcome was the mortality of patients with recanalization after acute BAO within 90 days. We used multivariable logistic regression modeling to estimate the association between Hcy and prognosis in our participants at 90 days.

Results: Altogether, 647 patients were assessed, and 302 patients were included in this study. The median was 12.88 μmol/L, and the mean Hcy concentration was 15.49 μmol/L. Elevated plasma Hcy levels (Hcy >12.88 μmol/L) were associated with poor functional outcomes (adjusted odds ratio 1.922, 95% confidence interval (CI) 1.048-3.528, P=0.035), but not with mortality (adjusted odds ratio 1.605, 95% CI 0.986-2.489, P=0.058). In further subgroup analysis, the conclusion was consistent in all predefined subgroups.

Conclusion: Our analysis suggests that elevated plasma Hcy levels have a predictive value for functional outcomes in patients with recanalization after acute BAO during the 90-day follow-up period, but not for mortality.

Keywords: Plasma homocysteine, acute basilar artery occlusion (ABAO), endovascular treatment, plasminogen activator, stroke, clinical prognosis.

[1]
Katan M, Luft A. Global burden of stroke. Semin Neurol 2018; 38(2): 208-11.
[http://dx.doi.org/10.1055/s-0038-1649503] [PMID: 29791947]
[2]
Buchman SL, Merkler AE. Basilar artery occlusion: Diagnosis and acute treatment. Curr Treat Options Neurol 2019; 21(10): 45.
[http://dx.doi.org/10.1007/s11940-019-0591-0] [PMID: 31555896]
[3]
Dias FA, Alessio-Alves FF, Castro-Afonso LH, et al. Clinical outcomes of patients with acute basilar artery occlusion in Brazil: An observational study. J Stroke Cerebrovasc Dis 2017; 26(10): 2191-8.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.04.043] [PMID: 28551292]
[4]
Kharitonova TV, Melo TP, Andersen G, Egido JA, Castillo J, Wahlgren N. Importance of cerebral artery recanalization in patients with stroke with and without neurological improvement after intravenous thrombolysis. Stroke 2013; 44(9): 2513-8.
[http://dx.doi.org/10.1161/STROKEAHA.111.000048] [PMID: 23881960]
[5]
Bai X, Zhang X, Li L, et al. Endovascular treatment versus standard medical treatment for acute basilar artery occlusion: Protocol for a systematic review and meta-analysis. BMJ Open 2020; 10(11): e040415.
[http://dx.doi.org/10.1136/bmjopen-2020-040415] [PMID: 33247016]
[6]
Gory B, Mazighi M, Labreuche J, et al. Predictors for mortality after mechanical thrombectomy of acute basilar artery occlusion. Cerebrovasc Dis 2018; 45(1-2): 61-7.
[http://dx.doi.org/10.1159/000486690] [PMID: 29393092]
[7]
Zhang T, Jiang Y, Zhang S, et al. The association between homocysteine and ischemic stroke subtypes in Chinese: A meta-analysis. Medicine (Baltimore) 2020; 99(12): e19467.
[http://dx.doi.org/10.1097/MD.0000000000019467] [PMID: 32195946]
[8]
Lehotský J, Tothová B, Kovalská M, et al. Role of homocysteine in the ischemic stroke and development of ischemic tolerance. Front Neurosci 2016; 10: 538.
[http://dx.doi.org/10.3389/fnins.2016.00538] [PMID: 27932944]
[9]
Ganguly P, Alam SF. Role of homocysteine in the development of cardiovascular disease. Nutr J 2015; 14: 6.
[http://dx.doi.org/10.1186/1475-2891-14-6] [PMID: 25577237]
[10]
cBaccarelli A, Wright R, Bollati V, et al. Ischemic heart disease and stroke in relation to blood DNA methylation. Epidemiology 2010; 21(6): 819-28.
[11]
Spence JD. Homocysteine lowering for stroke prevention: Unravelling the complexity of the evidence. Int J Stroke 2016; 11(7): 744-7.
[http://dx.doi.org/10.1177/1747493016662038] [PMID: 27462097]
[12]
Obeid R, Herrmann W. Mechanisms of homocysteine neurotoxicity in neurodegenerative diseases with special reference to dementia. FEBS Lett 2006; 580(13): 2994-3005.
[http://dx.doi.org/10.1016/j.febslet.2006.04.088] [PMID: 16697371]
[13]
Brattström L, Lindgren A, Israelsson B, et al. Hyperhomocysteinaemia in stroke: Prevalence, cause, and relationships to type of stroke and stroke risk factors. Eur J Clin Invest 1992; 22(3): 214-21.
[http://dx.doi.org/10.1111/j.1365-2362.1992.tb01829.x] [PMID: 1582447]
[14]
Zhou C, Wu J, Fang S. Meta-analysis of B vitamin supplementation on plasma homocysteine, cardiovascular and all-cause mortality. Clin Nutr 2013; 32(2): 314.
[http://dx.doi.org/10.1016/j.clnu.2013.01.001] [PMID: 23433911]
[15]
Bjørklund G, Peana M, Dadar M, et al. The role of B vitamins in stroke prevention. Crit Rev Food Sci Nutr 2021; 1-14.
[http://dx.doi.org/10.1080/10408398.2021.1885341] [PMID: 33724098]
[16]
Kwon HM, Lee YS, Bae HJ, Kang DW. Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke 2014; 45(3): 871-3.
[http://dx.doi.org/10.1161/STROKEAHA.113.004099] [PMID: 24448992]
[17]
Bos MJ, van Goor ML, Koudstaal PJ, Dippel DW. Plasma homocysteine is a risk factor for recurrent vascular events in young patients with an ischaemic stroke or TIA. J Neurol 2005; 252(3): 332-7.
[http://dx.doi.org/10.1007/s00415-005-0647-9] [PMID: 15739046]
[18]
Ye Z, Zhang Z, Zhang H, et al. Prognostic value of C-reactive protein and homocysteine in large-artery atherosclerotic stroke: A prospective observational study. J Stroke Cerebrovasc Dis 2017; 26(3): 618-26.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.016] [PMID: 27979431]
[19]
Perini F, Galloni E, Bolgan I, et al. Elevated plasma homocysteine in acute stroke was not associated with severity and outcome: Stronger association with small artery disease. Neurol Sci 2005; 26(5): 310-8.
[http://dx.doi.org/10.1007/s10072-005-0505-7] [PMID: 16388364]
[20]
Mizrahi EH, Fleissig Y, Arad M, Adunsky A. Plasma homocysteine level and functional outcome of patients with ischemic stroke. Arch Phys Med Rehabil 2005; 86(1): 60-3.
[http://dx.doi.org/10.1016/j.apmr.2004.01.031] [PMID: 15640990]
[21]
Zi W, Qiu Z, Wu D, et al. Assessment of endovascular treatment for acute basilar artery occlusion via a nationwide prospective registry. JAMA Neurol 2020; 77(5): 561-73.
[http://dx.doi.org/10.1001/jamaneurol.2020.0156] [PMID: 32080711]
[22]
Zhong C, Xu T, Xu T, et al. Plasma homocysteine and prognosis of acute ischemic stroke: A gender-specific analysis from catis randomized clinical trial. Mol Neurobiol 2017; 54(3): 2022-30.
[http://dx.doi.org/10.1007/s12035-016-9799-0] [PMID: 26910818]
[23]
Shi Z, Guan Y, Huo YR, et al. Elevated total homocysteine levels in acute ischemic stroke are associated with long-term mortality. Stroke 2015; 46(9): 2419-25.
[http://dx.doi.org/10.1161/STROKEAHA.115.009136] [PMID: 26199315]
[24]
Yan J, Liao JK, Wang D. Elevated homocysteine and C-reactive protein levels independently predict worsening prognosis after stroke in chinese patients. J Huazhong Univ Sci Technolog Med Sci 2010; 30(5): 643-7.
[http://dx.doi.org/10.1007/s11596-010-0557-7] [PMID: 21063849]
[25]
Meiklejohn DJ, Vickers MA, Dijkhuisen R, Greaves M. Plasma homocysteine concentrations in the acute and convalescent periods of atherothrombotic stroke. Stroke 2001; 32(1): 57-62.
[http://dx.doi.org/10.1161/01.STR.32.1.57] [PMID: 11136915]
[26]
Shi Z, Liu S, Guan Y, et al. Changes in total homocysteine levels after acute stroke and recurrence of stroke. Sci Rep 2018; 8(1): 6993.
[http://dx.doi.org/10.1038/s41598-018-25398-5] [PMID: 29725064]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy