Applicability of biomarkers in ischemic stroke

Cerebral ischemia results in the activation of a cascade of molecular events as a result of which several substances with the potential characteristics of biomarkers are released into the peripheral blood. Although still in the research phase, the analysis of these biomarkers in the serum has proved to be useful for stroke diagnosis, as well as for the prediction of the evolution of the ischemic lesion and the clinical prognosis. In fact, the feasibility and applicability of a panel of biomarkers for the diagnosis of stroke has recently been tested. Biomarkers of excitotoxicity, inflammation and oxidative stress have been demonstrated as being useful in the prediction of ischemic lesion enlargement and secondary neurological deterioration. On the other hand, biomarkers of endothelial damage have been shown to be especially helpful in the prediction of hemorrhagic transformation of the ischemic lesion, both spontaneously and after the administration of thrombolytic therapy, as well as in the prediction of brain edema with the secondary development of malignant middle-cerebral-artery infarction. Moreover, coagulation and fibrinolytic-cascade markers have been reported as being correlated with the recanalization rate after the administration of thrombolysis, and they might therefore be useful in estimating the effectiveness of thrombolytic therapy. However, for these biomarkers to become applicable to routine clinical practice, faster tests to perform the analyses are required and further studies must be undertaken to validate and generalize the results.