Abstract WP358: Distinct Serum Protein Profiles of Ischemic Stroke Thrombectomy Patients

Background: Stroke is the second leading cause of death globally, with 87% of cases being ischemic. Long-term outcome in ischemic stroke (IS) patients heavily relies on etiological, surgical, and medicinal treatment factors. However, a considerable portion of stroke cases are cryptogenic, complicating subsequent clinical decision-making. Proteomics may provide an avenue in aiding unknowns, as several proteins across studies have been associated with both stroke etiologies and outcome. We hypothesized pathophysiological mechanisms may be associated with particular biologic origin of clots, and short and long-term outcomes, identifiable through circulating serum proteins. Methods: Whole blood samples were collected from 80 patients with IS at the time of thrombectomy after admission to Gates Vascular Institute, Buffalo. Procartaplex assays were used to analyze plasma samples for levels of 32 cytokines and chemokines. Associations between etiologies (TOAST classification), short-term improvement measured by a decrease in ≥4 NIH Stroke Scale points over 24 hours post-stroke, long-term outcome dichtomized by Modified Rankin Scale 0-1 vs 2-6, and analytes were assessed using non-parametric and parametric testing. Results: 5 proteins were differentially present between 2 or more etiologies: cardioembolic (CE), large artery atherosclerotic (LAA), other, and undetermined. MCP-1 and VEGF-A were significantly different between groups CE and LAA (p=0.028 and p=0.017). Thrombopoietin was significantly different between groups CE and other, LAA and other, and undetermined and other (p=0.049, p=0.007, and p=0.002). There were differences between groups present in Myeloperoxidase (CE and other (p=0.038), undetermined and other (p=0.039)) and Oncostatin (LAA and undetermined (p=0.024)). With at least one protein level differing between each TOAST classification, future exploration in biomarker studies is supported. In a second analysis, post-hoc testing showed 8 proteins - VCAM-1 LAP, IL-33R (ST2), Adiponectin, CD62E (E-selectin), GDF-15, MCP-1 (CCL2), MIP-1 alpha (CCL3) - were different between groups who experienced early neurologic improvement or did not, in combination with either good or poor long-term outcomes. These profiles may be used to specify at-risk patients that may otherwise go unnoticed, and inform personalized treatment plans.