Key result
A high MMP-9 level at 6 hours from admission independently predicted infarct growth (OR 3.43) and hemorrhagic transformation (OR 2.91) in acute ischemic stroke patients treated with mechanical thrombectomy.
Why the study?
The relationship between matrix metalloproteinase 9, infarct growth, and hemorrhagic transformation in ischemic stroke with large vessel occlusion in the mechanical thrombectomy era remained to be assessed.
Does a high MMP-9 level at 6 hours predict infarct growth and hemorrhagic transformation in acute ischemic stroke patients treated with mechanical thrombectomy?
Cohort (n=148)
Single-blind
No
Does a high MMP-9 level at 6 hours predict infarct growth and hemorrhagic transformation in acute ischemic stroke patients treated with mechanical thrombectomy?
Odds Ratio: 3.43 (95% CI 1.23–9.55)
p-value: p=0.02
High MMP-9 levels at 6 hours post-admission independently predict infarct growth and hemorrhagic transformation in acute ischemic stroke patients treated with mechanical thrombectomy.
May identify high-risk thrombectomy patients but should not yet change practice; leaves open whether MMP-9 modulation improves outcomes.
Objective To assess the relationship between matrix metalloproteinase 9 (MMP-9), a proteolytic enzyme involved in the breakdown of the blood-brain barrier, and infarct growth and hemorrhagic transformation in ischemic stroke with large vessel occlusion (LVO) in the era of mechanical thrombectomy (MT) using the kinetics of MMP-9 and sequential magnetic resonance imaging (MRI). Methods HIBISCUS-STROKE is a cohort study including patients admitted for an ischemic stroke with LVO treated with MT following admission MRI. Patients underwent sequential assessment of MMP-9, follow-up CT at day 1 and MRI at day 6. The CT scan at day 1 classified any hemorrhagic transformation according to the European Co-operative Acute Stroke Study-II (ECASS II) classification. Infarct growth was defined as the difference between final Fluid-Attenuated Inversion Recovery volume and baseline diffusion-weighted imaging volume. Conditional logistic regression analyses were adjusted for main confounding variables including reperfusion status. Results Between 10/21/2016 and 04/12/2019, 148 patients met the inclusion criteria. A high MMP-9 level at 6 hours from admission (H6) (p=0.02), a high glucose level (p=0.01), a high temperature (p=0.04) and lack of reperfusion (p=0.02) were associated with infarct growth. A high MMP-9 level at H6 (p=0.03), a high glucose level (p=0.03) and a long delay from symptom onset to groin puncture (p=0.01) were associated with hemorrhagic transformation. Conclusions In this MT cohort study, MMP-9 level at H6 predicts infarct growth and hemorrhagic transformation.
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Mechtouff et al. (2020) conducted a cohort in Acute ischemic stroke with large vessel occlusion (n=148). High MMP-9 level (>775 ng/mL) at 6 hours vs. Low MMP-9 level (≤775 ng/mL) at 6 hours was evaluated on Infarct growth (dichotomized by median) (OR 3.43, 95% CI 1.23-9.55, p=0.02). A high MMP-9 level at 6 hours from admission independently predicted infarct growth (OR 3.43) and hemorrhagic transformation (OR 2.91) in acute ischemic stroke patients treated with mechanical thrombectomy.
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