Blood-Based Biomarkers Are Associated with Different Ischemic Stroke Mechanisms and Enable Rapid Classification between Cardioembolic and Atherosclerosis Etiologies

Abstract

Stroke is a top leading cause of death, which occurs due to interference in the blood flow of the brain. Ischemic stroke (blockage) accounts for most cases (87%) and is further subtyped into cardioembolic, atherosclerosis, lacunar, other causes, and cryptogenic strokes. The main value of subtyping ischemic stroke patients is for a better therapeutic decision-making process. The current classification methods are complex and time-consuming (hours to days). Specific blood-based biomarker measurements have promising potential to improve ischemic stroke mechanism classification. Over the past decades, the hypothesis that different blood-based biomarkers are associated with different ischemic stroke mechanisms is increasingly investigated. This review presents the recent studies that investigated blood-based biomarker characteristics differentiation between ischemic stroke mechanisms. Different blood-based biomarkers are specifically discussed (b-type natriuretic peptide, d-dimer, c-reactive protein, tumor necrosis factor-α, interleukin-6, interleukin-1β, neutrophil–lymphocyte ratio, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein and apolipoprotein A), as well as the different cut-off values that may be useful in specific classifications for cardioembolic and atherosclerosis etiologies. Lastly, the structure of a point-of-care biosensor device is presented, as a measuring tool on-site. The information presented in this review will hopefully contribute to the major efforts to improve the care for stroke patients.

Inhibition of Oxidative Stress: An Important Molecular Mechanism of Chinese Herbal Medicine (Astragalus membranaceus, Carthamus tinctorius L., Radix Salvia Miltiorrhizae, etc.) in the Treatment of Ischemic Stroke by Regulating the Antioxidant System

“…Plaque rupture and thrombosis result in the acute clinical complications of stroke. Ischemic stroke accounts for most cases (87%) in stroke and is further subtyped into atherosclerosis, cardioembolic, lacunar, other causes, and cryptogenic strokes [ 3 ]. Therefore, atherosclerosis is an important cause of ischemic stroke [ 4 ].…”

An increase in neutrophil-to-lymphocyte ratio predicts poor functional outcomes in older patients with acute ischemic stroke: a retrospective study

“…Numerous studies have reported that NLR is an independent risk factor of stroke severity, mortality and 3-month functional outcomes in acute is-chemic stroke [30,31,52]. A recent review concluded that NLR might be useful in specific classifications for cardioembolic and atherosclerosis etiologies [9]. Gokhan et al [30] reported that the NLR ratio was higher in the atherosclerotic stroke subtype than the other etiologies groups.…”

“…Recently, associations between blood-based biomarkers and ischemic stroke were reviewed [9]. As an important inflammatory marker, the neutrophil-to-lymphocyte ratio (NLR) has been identified and described in several coronary artery diseases [10][11][12], bacterial sepsis [13][14][15], pulmonary embolism [16] acute pancreatitis [17][18][19][20], appendicitis [21], acute physiological stress [22], and systematic inflammation and restless legs syndrome [23].…”

Association of Interleukin-6–174G/C Polymorphism With Ischemic Stroke: An Updated Meta-Analysis

“…The brain's response to ischemic injury can be regarded as an acute and long-term inflammatory process, characterized by rapid polarization of microglia, production of pro-inflammatory cytokines, and presentation of various leukocyte types into ischemic brain tissue, leading to IS occurrence and development ( 8 ). This was confirmed by increased concentrations in pro-inflammatory cytokines in the blood, cerebrospinal fluid in patients, and by studies of animal-induced experiments ( 9 ).…”