Timely and Blood-Based Multiplex Molecular Profiling of Acute Stroke

Abstract

Stroke is a leading cause of death and disability in the world. To address such a problem, early diagnosis and tailored acute treatment represent one of the major priorities in acute stroke care. Since the efficacy of reperfusion treatments is highly time-dependent, there is a critical need to optimize procedures for faster and more precise diagnosis. We provide a concise review of the most relevant and well-documented blood–protein biomarkers that exhibit greater potential for translational to clinical practice in stroke differential diagnosis and to differentiate ischemic stroke from hemorrhagic stroke, followed by an overview of the most recent point-of-care technological approaches to address this problem. The integration of fluid-based biomarker profiling, using point-of-care biosensors with demographic, clinical, and neuroimaging parameters in multi-dimensional clinical decision-making algorithms, will be the next step in personalized stroke care.

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

“…Recent studies have highlighted the potential of blood-derived parameters as biomarkers for timely patient triage, therapeutics, and stroke mechanisms [ 30 , 31 , 32 ]. Easily accessible fluid biomarkers can provide an objective evaluation of the real-time panorama, supporting stroke diagnosis or predicting the patients’ outcome and ultimately guiding clinical decisions [ 20 , 32 , 33 , 34 , 35 ]. Cognitive impairment tends to progressively worsen following stroke, with 20–30% of patients developing dementia [ 9 , 36 ].…”

Early plasma biomarker dynamic profiles are associated with acute ischemic stroke outcomes

“…In the future, the rate of plasma GFAP, NfL and t-tau concentration change in patients with AIS, with a first sample taken in the pre-hospital setting, could help stroke physicians to identify rapidly progressing AIS patients and assist in determining infarct extension by complementing neuroimaging modalities. For this, biomarker assessment needs to be quick, inexpensive and deliver a readily available result for interpretation, like point-of-care devices that are currently under evaluation for GFAP in TBI patients to avoid CT scanning [40][41][42].…”

Neurovascular Unit-Derived Extracellular Vesicles: From Their Physiopathological Roles to Their Clinical Applications in Acute Brain Injuries

“…However, those therapies can only be initiated after the exclusion of hemorrhagic patients to avoid increased bleeding. The diagnosis of ischemic stroke currently relies on neuroimaging, such as computerized tomography (CT) or magnetic resonance imaging (MRI) [ 145 ]. However, acute strokes (ischemic or hemorrhagic) are detected in 80% of patients with MRI and two thirds with non-contrast CT [ 146 ].…”

“…However, acute strokes (ischemic or hemorrhagic) are detected in 80% of patients with MRI and two thirds with non-contrast CT [ 146 ]. In addition, MRI is not available in every hospital, CT scans require radiation exposure, and both are costly and cannot be performed at the prehospital level [ 145 ]. As a result, fewer than 10% of ischemic stroke patients receive thrombolysis mainly due to late admission, uncertainty about the stroke type or potential salvageable brain tissue [ 147 , 148 ].…”