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Endothelial dysfunction and procoagulant activity in acute ischemic stroke
Arnon Blum1, Vladimir Vaispapir, Lital Keinan-Boker
1Department of Medicine, Baruch-Padeh Poriya Medical Center, Lower Galilee 15208, Israel.
Journal of Vascular and Interventional Neurology
|June 28, 2012
Summary
Acute ischemic stroke is linked to significant endothelial dysfunction and elevated P-selectin levels, indicating ongoing vascular instability and increased risk for further vascular events in the initial days post-stroke.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Biology
Background:
- Endothelial dysfunction, a marker of inflammation, is observed in stroke patients and linked to stroke pathophysiology, severity, and outcomes.
- Systemic vascular function assessment is crucial for understanding stroke mechanisms and patient prognosis.
Purpose of the Study:
- To directly measure systemic vascular function using forearm flow-mediated dilation (FMD) in patients with acute ischemic stroke.
- To determine if acute ischemic stroke is associated with impaired vascular function and elevated inflammatory markers like P-selectin.
Main Methods:
- Forty-three acute ischemic stroke patients (excluded from thrombolysis) and 23 healthy male controls were enrolled.
- Vascular responsiveness was assessed via ankle-brachial index (ABI) and endothelial function (FMD) on admission.
- P-selectin levels were measured within 24 hours and on day 4 post-stroke.
Main Results:
- Stroke patients exhibited significantly worse endothelial dysfunction (FMD: -4.4±7.4% vs. 16.6±7.6% in controls, p=0.001) and higher BMI.
- P-selectin levels were elevated on admission (68.0±55.5 pg/ml) and increased by day 4 (102.3±72.0 pg/ml, p=0.01).
- Neurological deficit scores improved significantly from admission to day 4 (p=0.001).
Conclusions:
- Patients with acute ischemic stroke present with severe endothelial dysfunction and elevated P-selectin levels within the first 24 hours.
- These inflammatory markers increase further in the first week, suggesting ongoing vascular instability and procoagulant activity.
- Patients remain at heightened risk for subsequent vascular events in the initial days following an acute stroke.
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