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Association between lipoprotein(a) and peri-procedural ischemic stroke in intracranial artery stenting: a
Fan Qingyu1, Zhan Shuqin1, Li Fangcun1
1Department of Neurology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Insights
Preoperative Lipoprotein(a) [Lp(a)] levels independently predict peri-procedural ischemic stroke (PPIS) after intracranial stenting. Elevated Lp(a) increases PPIS risk, aiding in better patient stratification.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Peri-procedural ischemic stroke (PPIS) is a significant complication of intracranial stenting for symptomatic intracranial atherosclerotic stenosis (ICAS).
- Lipoprotein(a) [Lp(a)] is a known risk factor for long-term vascular events, but its predictive role for acute, procedure-specific risks like PPIS remains unclear.
Purpose of the Study:
- To determine if preoperative Lp(a) independently predicts PPIS in patients undergoing intracranial stenting.
- To characterize the dose-response relationship between Lp(a) levels and PPIS risk.
- To evaluate the incremental value of Lp(a) in stratifying risk for PPIS.
Main Methods:
- Retrospective analysis of patients with severe symptomatic ICAS undergoing stenting.
- Stratification of patients based on preoperative Lp(a) levels (cutoff: 30 mg/dL).
- Multivariate logistic regression, ROC analysis, and continuous net reclassification improvement (NRI) were used to assess Lp(a)'s predictive value.
Main Results:
- PPIS occurred in 7.7% of patients, with a higher incidence in the high Lp(a) group (14.6% vs. 4.4%).
- Elevated preoperative Lp(a) was an independent predictor of PPIS (aOR=2.82), even after adjusting for stenosis rate and hyperglycemia.
- Incorporating Lp(a) into risk models improved predictive accuracy (AUC increased from 0.727 to 0.766, NRI=0.421).
Conclusions:
- Preoperative Lp(a) is an independent predictor of PPIS following intracranial stenting, demonstrating a dose-response relationship.
- Lp(a) provides valuable information for risk stratification in patients undergoing ICAS stenting.
- Further multicenter validation is recommended due to the single-center design and limited event numbers.
Background And Objectives:
Peri-procedural ischemic stroke (PPIS) is the primary complication limiting the benefit of intracranial stenting for symptomatic intracranial atherosclerotic stenosis (ICAS). Lipoprotein(a) [Lp(a)] is a known risk factor for long-term vascular events, but its role in predicting acute procedure-specific risk is unknown. This study aimed to determine whether preoperative Lp(a) independently predicts PPIS, characterize its dose-response relationship, and evaluate its incremental value for risk stratification.
Methods:
We retrospectively analyzed patients with severe symptomatic ICAS who underwent stenting (2020-2024). Patients were stratified by preoperative Lp(a) (cutoff: 30 mg/dL). Primary outcome was PPIS within 30 days. Multivariate logistic regression assessed the independent association. Model performance was evaluated using ROC and continuous net reclassification improvement (NRI). A restricted cubic spline model visualized the dose-response relationship.
Results:
PPIS occurred in 33 patients (7.7%). Incidence was higher in the high Lp(a) group (14.6% vs. 4.4%, p=0.001). After adjusting for stenosis rate and preoperative hyperglycemia, high Lp(a) remained an independent predictor (aOR=2.82, 95%CI 1.35-5.89). Adding Lp(a) improved AUC from 0.727 to 0.766 (NRI=0.421, p=0.019). Restricted cubic spline revealed a monotonically increasing, non-linear relationship between Lp(a) and PPIS risk.
Conclusion:
Preoperative Lp(a) independently predicts PPIS with a dose-response relationship, offering ancillary information for risk stratification. Given the single-center design and limited events, these findings require multicenter validation.
