Endothelial Dysfunction and Parenchymal Hematoma in Ischemic Stroke Patients after Endovascular Thrombectomy

Abstract

Background and Purpose: Endothelial dysfunction (ED) may result in parenchymal injury and, therefore, worsen the outcomes of ischemic stroke. This study aimed to determine whether ED could predict parenchymal hematoma (PH) in ischemic stroke patients treated with endovascular thrombectomy (EVT). Methods: Patients with large artery occlusion in the anterior circulation and treated with EVT were prospectively enrolled from 2 stroke centers. Serum soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, soluble E-selectin, and von Willebrand factor (vWF) were tested and summed to a standardized score to reflect the levels of ED. PH was diagnosed according to the Heidelberg Bleeding Classification. Results: Of the 325 enrolled patients (mean age, 68.6 years; 207 men), 41 (12.6%) developed PH. Patients with PH had higher concentrations of soluble E-selectin, vWF, and ED sum score. After adjusting for demographic characteristics, National Institutes of Health Stroke Scale score, pre-treatment Alberta stroke program early computerized tomography score, and other potential confounders, the increased ED burden was associated with PH (odds ratio, 1.432; 95% confidence interval, 1.031−1.988; P=0.032). Similar significant results were found in the sensitivity analysis. The multiple-adjusted spline regression model showed a linear association between the total ED score and PH (P=0.001 for linearity). Adding ED score to the conventional model significantly improved the risk prediction of PH (net reclassification improvement=25.2%, P=0.001; integrated discrimination index=2.9%; P=0.001). Conclusions: This study demonstrated that ED might be related to PH. Introducing the ED score could increase the reliability of PH risk model for stroke patients treated with EVT.

Emerging diagnostic markers and therapeutic targets in post-stroke hemorrhagic transformation and brain edema

“…However, the dynamic between vWF, thrombogenesis, reperfusion injury, and inflammation can create conditions conducive to BBB disruption and, subsequently, HT ( Zhu et al, 2016 ). Patients with higher vWF levels post-stroke are at a higher risk of HT, especially following thrombolytic therapy ( Zhang et al, 2023 ). The increased risk might be related to the concomitant BBB disruption and microvascular occlusions.…”