Vascular Endothelial Growth Factor-A and Collateral Circulation in Patients with Acute Ischemic Stroke due to...

Collateral circulation (CC) plays a critical role in stroke progression and vascular endothelial growth factor-A (VEGF-A) is a key angiogenic mediator. The aim of the study was to evaluate the association between VEGF-A plasma levels and CC in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) who received endovascular therapy (EVT). We conducted a prospective multicentre study of patients with LVO-AIS who received EVT. Blood samples were collected on admission to measure VEGF-A plasma levels. CC was assessed by automated collateral scoring on baseline CT angiography and classified from 0 to 3, later dichotomized into poor (0-1) and good (2-3) CC. Multivariable logistic regression analyses were performed to explore the association between VEGF-A and CC. Included were 290 patients (73.4 ± 13.5 years, 50.0% women), previous mRS median score was 0 (IQR 0-1) and the baseline NIHSS median score was 16 (IQR 9-20). Higher baseline VEGF-A levels were independently associated with better CC (cOR_{x1 log increase of VEGF-A}= 1.83, 95% CI 1.18-2.83; p = 0.007) adjusted for age and known-onset of symptoms < 6 h. A VEGF-A threshold < 14pg/mL identified poor CC with high specificity (75.2%) and was inversely associated with the probability of presenting good CC (aOR = 0.53, 95%CI 0.29-0.96; p = 0.036). No significant association was found between VEGF-A levels and 3-months functional outcome. Circulating VEGF-A levels wereindependently associated with CC status in AIS patients with anterior LVO treated with EVT. While this finding suggests a potential biological link between VEGF-A and collateral function, it should be interpreted as an association rather than a causal relationship.