Background and Aims: Reperfusion therapies may increase hemorrhagic transformation (HT) and worsen brain edema in acute ischemic stroke. Our objective is to predict HT or malignant brain edema before and after reperfusion therapy by analyzing serum endothelin-1 (ET-1). Methods: We hypothesize that serum ET-1 levels: 1) increase early in response to cerebral ischemia before therapy and increase to a greater extent after reperfusion therapy; and 2) correlate with HT or malignant brain edema. We proposed a cross-sectional cohort study. Acute ischemic strokes were diagnosed by neurologist and supported by CT scan. The patients were eligible for intravenous administration of rtPA in 4.5 hours and for mechanical thrombectomy (EVT) in 6 hours after symptom onset according to predefined protocols in a comprehensive stroke center in Taiwan. We measured serum ET-1 levels by ELISA. Results: We enrolled 29 patients 20 years or older who underwent reperfusion therapy. The mean age was 67 years. The number of males was 12. Of 29 patients, 8 patients received rtPA, 18 patients underwent EVT, and 3 patients were treated with both. After reperfusion therapy, HT occurred in 13 patients and malignant brain edema developed in 5 patients. There was a non-significant trend that serum ET-1 levels were higher in patients with HT or malignant brain edema (127.0±49.7 ng/mL) than in patients without HT and malignant brain edema (111.0.0±50.6 ng/mL). Conclusions: The serum ET-1 level is a potential biomarker for predicting HT and malignant brain edema after reperfusion therapy in acute ischemic stroke.
Date:
2023-10-10
Relation:
International Journal of Stroke. 2023 Oct 10;18(3):298.
