Abstract 229: Recanalization Rate in Mechanical Thrombectomy in Patients With Elevated LDL‐C Levels

Introduction A high level of low‐density lipoprotein ‐ cholesterol (LDL‐C) is a known risk factor for ischemic stroke1. However, the impact of LDL‐C on stroke outcomes after mechanical thrombectomy (MT) is unclear. Interestingly, previous studies have shown conflicting evidence. Some studies showed higher LDL‐C early in the course of stroke is associated with a favorable post‐MT outcome and a lower risk of hemorrhage2,3 whereas others showed higher LDL‐C is associated with a higher risk of hemorrhagic transformation4. In this study, we aim to examine the relationship between LDL‐C level and post‐MT functional outcome. We also aim to investigate whether LDL‐C levels affect MT recanalization rate. Methods We reviewed the records of 223 patients who received MT at our institution from 2018‐2023. We collected data on baseline characteristics and demographics, functional outcomes at discharge and 90 days, and procedural information including final thrombolysis in cerebral infarction (TICI) grade. Univariate analysis included chi‐square and Mann‐Whitney U tests. Multivariable logistic regression models were fitted to determine the odds of the outcomes while adjusting for age, race, and gender. Results Of the patients who received MT, 69 (31.9%) had elevated LDL‐C levels of 100 or higher. Patients with elevated LDL were 47% less likely to achieve TICI 3 status after adjustment for age, race, and gender (aOR =0.53, 95%CI = 0.30‐0.95, p=0.03). There were no statistically significant differences in 90‐day modified Rankin Scale (mRS), or discharge mRS. However, only 81.2% of patients with an elevated LDL‐C had an unfavorable mRS (>=3) at discharge compared with 87.0% of those with a normal LDL‐C level (<100). Conclusion In our cohort, elevated LDL‐C level was significantly associated with poor recanalization rate in MT. Patients with elevated LDL‐C levels more frequently had favorable functional outcomes (mRS<3) after MT even though this effect was not statistically significant in our study. To our knowledge, no studies have examined the relationship between LDL‐C and MT recanalization rate. This association we observed might explain the relationship between good functional outcomes and elevated LDL‐C levels found in our study and the previous studies. Previous literature demonstrated that the composition of thrombus can have an impact on the efficacy of MT5. Whether LDL‐C level is involved in this mechanism is yet unknown. Future research on the pathophysiological mechanisms underlying this observation is warranted.