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Yao Y, Liu F, Gu Z, Wang J, Xu L, Yu Y, Cai J, Ren R. Emerging diagnostic markers and therapeutic targets in post-stroke hemorrhagic transformation and brain edema. Front Mol Neurosci 2023; 16:1286351. [PMID: 38178909 PMCID: PMC10764516 DOI: 10.3389/fnmol.2023.1286351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
Stroke is a devastating condition that can lead to significant morbidity and mortality. The aftermath of a stroke, particularly hemorrhagic transformation (HT) and brain edema, can significantly impact the prognosis of patients. Early detection and effective management of these complications are crucial for improving outcomes in stroke patients. This review highlights the emerging diagnostic markers and therapeutic targets including claudin, occludin, zonula occluden, s100β, albumin, MMP-9, MMP-2, MMP-12, IL-1β, TNF-α, IL-6, IFN-γ, TGF-β, IL-10, IL-4, IL-13, MCP-1/CCL2, CXCL2, CXCL8, CXCL12, CCL5, CX3CL1, ICAM-1, VCAM-1, P-selectin, E-selectin, PECAM-1/CD31, JAMs, HMGB1, vWF, VEGF, ROS, NAC, and AQP4. The clinical significance and implications of these biomarkers were also discussed.
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Affiliation(s)
- Ying Yao
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Liu
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaowen Gu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lintao Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Yu
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Cai
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Reng Ren
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Thorén M, Azevedo E, Dawson J, Egido JA, Falcou A, Ford GA, Holmin S, Mikulik R, Ollikainen J, Wahlgren N, Ahmed N. Predictors for Cerebral Edema in Acute Ischemic Stroke Treated With Intravenous Thrombolysis. Stroke 2017; 48:2464-2471. [PMID: 28775140 DOI: 10.1161/strokeaha.117.018223] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral edema (CED) is a severe complication of acute ischemic stroke. There is uncertainty regarding the predictors for the development of CED after cerebral infarction. We aimed to determine which baseline clinical and radiological parameters predict development of CED in patients treated with intravenous thrombolysis. METHODS We used an image-based classification of CED with 3 degrees of severity (less severe CED 1 and most severe CED 3) on postintravenous thrombolysis imaging scans. We extracted data from 42 187 patients recorded in the SITS International Register (Safe Implementation of Treatments in Stroke) during 2002 to 2011. We did univariate comparisons of baseline data between patients with or without CED. We used backward logistic regression to select a set of predictors for each CED severity. RESULTS CED was detected in 9579/42 187 patients (22.7%: 12.5% CED 1, 4.9% CED 2, 5.3% CED 3). In patients with CED versus no CED, the baseline National Institutes of Health Stroke Scale score was higher (17 versus 10; P<0.001), signs of acute infarct was more common (27.9% versus 19.2%; P<0.001), hyperdense artery sign was more common (37.6% versus 14.6%; P<0.001), and blood glucose was higher (6.8 versus 6.4 mmol/L; P<0.001). Baseline National Institutes of Health Stroke Scale, hyperdense artery sign, blood glucose, impaired consciousness, and signs of acute infarct on imaging were independent predictors for all edema types. CONCLUSIONS The most important baseline predictors for early CED are National Institutes of Health Stroke Scale, hyperdense artery sign, higher blood glucose, decreased level of consciousness, and signs of infarct at baseline. The findings can be used to improve selection and monitoring of patients for drug or surgical treatment.
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Affiliation(s)
- Magnus Thorén
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.).
| | - Elsa Azevedo
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Jesse Dawson
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Jose A Egido
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Anne Falcou
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Gary A Ford
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Staffan Holmin
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Robert Mikulik
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Jyrki Ollikainen
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Nils Wahlgren
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
| | - Niaz Ahmed
- From the Department of Neurology (M.T., N.A.), and Department of Neuroradiology (S.H.), Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.); Department of Neurology, São João Hospital Center, and Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal (E.A.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, United Kingdom (J.D.); Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain (J.A.E.); Emergency Department Stroke Unit, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Italy (A.F.); Acute Stroke Service, Oxford University Hospitals NHS Foundation Trust, and Radcliffe Department of Medicine, Oxford University, United Kingdom (G.A.F.); International Clinical Research Center and Department of Neurology, St Anne's University Hospital Brno, and Faculty of Medicine, Masaryk University, Czech Republic (R.M.); and Department of Neurology, Tampere University Hospital, Finland (J.O.)
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