Blood Biomarkers for Large Vessel Occlusions: A Systematic Review

Large vessel occlusions (LVOs), which account for approximately 25% of ischemic strokes, pose a significant challenge due to their severe impact and need for rapid diagnosis and treatment. Current diagnostic approaches-primarily based on clinical scales and imaging-often lack specificity or delay treatment, severely impacting patient outcomes. This review aims to evaluate the potential of blood biomarkers in improving the accuracy and efficiency of LVO diagnosis.

A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted with specific inclusion/exclusion criteria and multiperson screening. PubMed, Google Scholar, and Embase were searched using targeted queries related to LVO and biomarkers. Studies reporting the diagnostic accuracy, sensitivity, and specificity of blood biomarkers for LVO were included. Data were extracted and synthesized to categorize biomarkers and assess their diagnostic utility.

Sixteen studies were included, categorizing biomarkers into 5 groups: coagulation and hemostasis, acute brain injury, inflammatory, angiogenic growth factors, and metabolic and structural markers.

The review highlights the critical role of biomarker blood testing to enhance LVO diagnosis, especially in acute clinical settings. Coagulation and hemostasis markers such as D-dimer offer rapid thrombus detection, and acute brain injury and angiogenic biomarkers provide insight into the extent of injury, localization, and vascular response. A combination of biomarkers from multiple categories is needed to provide an accurate clinical picture of LVO in patients. Excluding studies on embolic strokes, including cardioembolic subtypes, may also bias findings by neglecting their distinct biomarker profiles, warranting further investigation to fully assess biomarker utility across stroke etiologies. Despite promising results for multiple biomarkers, including glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, and D-dimer, further research is needed to validate these biomarkers in diverse populations and integrate them into clinical practice effectively.