To investigate the relationship between low-density lipoprotein (LDL-C) cholesterol concentration and outcomes after mechanical thrombectomy (MT) in stroke.

Recent retrospective and prospective studies have argued for a protective effect of higher LDL-C in anterior circulation ischemic stroke patients after MT, and in risk of intracranial hemorrhage in a healthy population. Our study further examines the association between LDL-C and hemorrhagic conversion (HC) in acute ischemic stroke patients who have undergone MT.

A retrospective observational study of 348 patients undergoing MT from February 2015 to July 2018 was conducted at a large comprehensive stroke center. Serum LDL-C concentrations were assessed on admission for acute ischemic stroke. Incident HC was confirmed by review of medical records for that hospitalization period. Univariate and multivariate regression models were used and outcomes were adjusted for demographics, baseline characteristics and peri-procedural and systemic complications.

A total of 336/348 patients undergoing MT had LDL-C values reported. Mean age was 71±14 (50% female, 24% African American, 42% Hispanic, 32% history of hyperlipidemia). Mean LDL-C was 85±40, median baseline modified Rankin Scale score (mRS) of 0 [IQR 0 -1], and mean admission NIHSS of 16 [IQR 11-20]. There was no statistically significant difference in odds of HC or symptomatic intracranial hemorrhage (sICH) among participants with LDL concentrations of <70 mg/dL compared with LDL-C concentrations ≥70 mg/dL, OR 0.86 [CI 0.54-1.38]. Similarly the odds of significant functional disability (mRS >3) at discharge was not significantly affected by LDL-C concentration, OR 0.81 [CI 0.51-1.27].

We did not observe a significant association between lower LDL-C and higher risk of HC, sICH or discharge mRS in acute ischemic stroke patients who have undergone mechanical thrombectomy.