The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy

Neurol Res. 2016 Sep;38(9):759-65. doi: 10.1080/01616412.2016.1215030. Epub 2016 Jul 30.


Objectives: Of all strokes, 85% are ischemic and intracranial artery occlusion accounts for 80% of these ischemic strokes. Endovascular therapy for acute ischemic stroke was a new modality aiming at resolution of clots in occluded cerebral arteries. The platelet-to-lymphocyte ratio (PLR) was introduced as a potential marker to determine increased inflammation, which is a result of releasing many mediators from the platelets. In this study we aimed to evaluate whether the PLR had a prognostic role in stroke patients undergoing thrombectomy and attempted to determine the effect that this ratio had on their survival.

Methods: Over a three-year period, demographic, clinical, and angiographic findings of 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy were evaluated.

Results: The patients were divided into two groups on the basis of a PLR level cut-off value of 145 based on receiver operating characteristic (ROC) curve. Successful revascularization (mTICI 2b and 3) was achieved in 42 of 57 (73.7%) patients; a mTICI 3 state was observed in 21 of 23 patients with low-PLR values (p = .015). Patients with higher PLR values had significantly a score of less than six on the ASPECT scale compared to patients with lower PLR values (p = .005). The patients with low-PLR values had better functional outcomes (mRS ≤ 2) compared with the patients with high-PLR values [respectively, p = .004 (at first month) and p = .014 (at third month)].

Discussion: The platelet-to-lymphocyte ratio could represent pro-thrombotic inflammatory state in acute ischemic stroke patients because having a high-PLR values increased the poor prognosis, the rate of insufficient recanalization, and the size of infarcted area.

Keywords: Acute stroke; Endovascular treatment; Patient outcome; Platelet/lymphocyte ratio.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Platelets / pathology*
  • Brain Infarction / etiology*
  • Brain Infarction / pathology*
  • Brain Ischemia / complications
  • Endovascular Procedures / adverse effects*
  • Female
  • Humans
  • Longitudinal Studies
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • ROC Curve
  • Retrospective Studies
  • Severity of Illness Index
  • Stroke / etiology
  • Stroke / pathology
  • Stroke / surgery