Microbleeds and free active MMP-9 are independent risk factors for neurological deterioration in acute lacunar stroke

Area of Science:

• Neurology
• Neuroimaging
• Biochemistry

Background:

• Acute lacunar stroke is a significant cause of neurological deficits.
• Microbleeds and matrix metalloproteinase-9 (MMP-9) are implicated in cerebrovascular diseases.
• Understanding their relationship in lacunar stroke is crucial for predicting outcomes.

Purpose of the Study:

• To evaluate the association between microbleeds, matrix metalloproteinase-9 (MMP-9), and neurological deterioration in patients experiencing their first acute lacunar stroke.
• To identify potential predictors of neurological worsening in this patient population.

Main Methods:

• A prospective study included 206 patients with their first acute lacunar stroke confirmed by diffusion-weighted imaging.
• Gradient-recalled echo (GRE) MRI and blood samples for free, active MMP-9 were obtained within 24 hours of stroke onset.
• Neurological deterioration was assessed using the National Institutes of Health Stroke Scale (NIHSS) score at 14 days.

Main Results:

• Microbleeds were present in 38.3% of patients, and 23.3% experienced neurological deterioration.
• Significantly higher levels of free, active MMP-9 and C-reactive protein (CRP) were observed in patients with microbleeds.
• Microbleeds (RR=2.47) and elevated free, active MMP-9 (RR=1.10 per 10 ng/ml) were independent risk factors for neurological deterioration.

Conclusions:

• Elevated active MMP-9 levels and the presence of microbleeds are associated with neurological deterioration after acute lacunar stroke.
• These findings suggest that MMP-9 and microbleeds can serve as predictive markers for clinical worsening.
• Further research can explore therapeutic strategies targeting MMP-9 to mitigate stroke progression.