Abstract A139: Plasma Proteomics Nominate Biomarker Candidates Of Acute Large Vessel Occlusion Strokes

Introduction: Early prehospital identification of patients with acute large vessel occlusion (LVO) is critical for timely triage to thrombectomy-capable centers. Objectives: We undertook a cross-hospital proteomics study to identify plasma biomarkers of LVO. Methods: We analyzed clinical and proteomics data from stroke patients aged ≥18 years using two prospective repositories from 2010 to 2020 at Grady Memorial Hospital (GMH) and Yale New Haven Hospital (YNHH). Plasma was collected at emergency room presentation before any intervention at GMH and within 72 hours of stroke onset at YNHH. Our primary objective was to identify differentially abundant protein (DAP) levels in LVO versus non-LVO strokes. Our secondary objective was DAPs in LVO versus acute ischemic stroke (AIS) without LVO, intracerebral hemorrhage (ICH), transient ischemic attack (TIA), and stroke mimics (MIM). We performed aptamer-based proteomics (7K SomaScan) on both cohorts. DAPs were identified using an unadjusted p-value 0.88 (Figure 3B). GH2, C1QL2, and CD2 also classified LVO from non-LVO AIS, ICH, TIA, and MIM with AUCs >0.81 after NIHSS adjustment (Figure 3C). Conclusions: Our externally validated proteomics study identified concordant protein panels that enhance prehospital scales for LVO detection, aiding thrombectomy triage. These findings warrant validation in larger, multicenter cohorts.