Vascular Health and Risk Management (Aug 2025)
Predictive Utility of PLR and Platelet-to-LDL Ratio for in-Stent Restenosis Following Carotid Artery Stenting
Abstract
Ling Ma,1 Hu Xu,2 Huatao Li,3 Dianwei Liu3 1Department of Clinical Laboratory, The Second Qilu Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 2Department of Stroke Center, Shandong Second Medical University, Weifang, Shandong, 261000, People’s Republic of China; 3Department of Stroke Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250013, People’s Republic of ChinaCorrespondence: Dianwei Liu, Department of Stroke Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250100, People’s Republic of China, Tel +86 531 13370587726, Email [email protected]: Carotid artery stenting (CAS) has been widely used to remodel the vascular structure and restore the blood flow for preventing ischemic stroke. However, in-stent restenosis (ISR) after CAS is extremely associated with an increased risk of ischemic stroke recurrence.Objective: The aim of this study was to explore potential predict biomarkers for ISR after CAS.Methods: In this study, data from 221 patients with CAS, which was divided into no-ISR group and ISR group, and 145 healthy controls were retrospectively analyzed. The ratios of neutrophil, lymphocyte, monocyte, platelet, glucose (Glu), and triglyceride (TG) to lymphocyte, HDL, and LDL were analyzed, respectively. In addition, the ratios of SII, SIRI, and AISI were analyzed as the following formulas: SII = platelet × neutrophil-to-lymphocyte ratio, SIRI = monocyte × neutrophil-to-lymphocyte ratio, and AISI = neutrophil × platelet × monocyte-to-lymphocyte ratio. ROC curve analysis was performed to analyze the predict roles of PLR and platelet/LDL for ISR.Results: The ratios of NLR, PLR, Glu/lymphocyte, TG/lymphocyte, NHR, PHR, Glu/HDL, TG/HDL, neutrophil/LDL, platelet/LDL, Glu/LDL, TG/LDL, and SII increased in patients with CAS, indicating the predict roles of these values in carotid artery stenosis. Most importantly, increased ratios of PLR and platelet/LDL before the first operation of CAS, but not the second operation, were found in ISR patients after CAS as compared with no-ISR group. ROC analysis showed a more effective role of PLR for predicting ISR. While PLR showed high specificity (96.95%), its modest sensitivity (35.29%) suggests the need for complementary biomarkers in clinical practice.Conclusion: These results indicate that ratios of PLR and platelet/LDL before the first CAS operation can act as the predict biomarkers of ISR.Plain Language Summary: Type of Research: Single-center retrospective cohort study.Key Findings: Increased ratios of PLR and platelet/LDL before the first operation of carotid artery stenting (CAS), but not the second operation, were found in in-stent restenosis (ISR) patients after CAS as compared with no-ISR group. ROC analysis showed the potential role of PLR for predicting ISR.Take home Message: The ratios of PLR and platelet/LDL before the first CAS operation can act as the predict biomarkers of ISR.Summary: In this retrospective study of 221 patients, ratios of PLR and platelet/LDL increased in the ISR patients before the first, but not the second, operation of CAS. The ratios of PLR and platelet/LDL before the first CAS operation can act as the predict biomarkers of ISR.Keywords: carotid artery stenting, in-stent restenosis, PLR, platelet to LDL ratio, biomarker
