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Ischemic Stroke ll: Pathophysiology

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An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...

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Updated: Jun 11, 2026

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

Endothelial activation in lacunar stroke subtypes.

Iris L H Knottnerus¹, Jose W P Govers-Riemslag, Karly Hamulyak

¹Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands. iris.knottnerus@home.nl

|July 3, 2010

Summary

This summary is machine-generated.

Endothelial activation markers, tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1), were analyzed in lacunar stroke (LS) patients. Higher tPA and lower PAI-1 levels were associated with white matter lesions (WML), suggesting endothelial dysfunction in this LS subtype.

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Area of Science:

Neurology
Vascular Biology
Biochemistry

Background:

Lacunar stroke (LS) is a type of ischemic stroke.
LS can be subtyped into isolated lacunar infarct (ILA) or LS with white matter lesions (WML) and/or asymptomatic lacunar infarcts.
Endothelial activation is hypothesized to be involved in LS subtypes with WML.

Purpose of the Study:

To investigate the association between endothelial activation markers and WML in LS patients.
To determine if endothelial activation differs between LS subtypes.

Main Methods:

149 LS patients underwent brain MRI.
Levels of circulating endothelial function markers including tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) were measured.
Marker levels were correlated with LS subtypes and adjusted for covariates.

Main Results:

Patients with WML showed significantly higher tPA activity compared to ILA patients (0.79 vs 0.44 IU/mL).
PAI-1 antigen levels were significantly lower in patients with WML compared to ILA patients (27.5 vs 44.0 ng/mL).
The association between WML and lower PAI-1 levels remained significant after multivariable analysis.

Conclusions:

Findings support the hypothesis of endothelial activation in LS subtypes characterized by diffuse small vessel vasculopathy.
Elevated tPA levels in patients with WML suggest increased fibrinolytic activity.
Lower PAI-1 levels associated with WML may indicate altered fibrinolysis contributing to white matter lesion development.