The role of endothelial dysfunction in the age-related poor prognosis of stroke patients undergoing endovascular treatment.

BACKGROUND

Age is a well-established predictor of poor prognosis in patients with ischemic stroke (IS) undergoing endovascular treatment (EVT). The endothelium plays a central role in the pathophysiology of IS, and its function can be evaluated using various methods. This study aims to investigate the relationship between endothelial dysfunction, age, and clinical outcomes in IS patients treated with EVT METHODS: Patients with IS treated with EVT were included in the study. Ninety-day prognosis was evaluated using the modified Rankin Scale (mRS). Endothelial function was assessed through flow-mediated dilation (FMD) measured by brachial artery ultrasound, and by quantifying pre-EVT arterial serum levels of arginine metabolites, homoarginine (hArg), symmetric dimethylarginine (SDMA), and asymmetric dimethylarginine (ADMA), using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Clinical, radiological, and EVT procedural data were recorded as independent variables. The outcome variable is good functional outcome by dichotomized mRS<2. Bivariate, multivariate, and mediation analyses were conducted to explore associations.

RESULTS

A total of 150 stroke patients were included in the analysis (median age was 77 years and 50.7 % were female). Older patients exhibited poorer endothelial function, reflected by lower FMD values and altered arginine metabolite profiles. They also showed worse clinical outcomes at 90 days. Among the metabolites, SDMA emerged as an independent predictor of poor prognosis (OR = 1.343 per 0.1 umol/l increase, p < 0.01). Moreover, SDMA was identified as a mediator in the relationship between age and unfavorable outcomes following EVT CONCLUSION: Endothelial dysfunction, as indicated by circulating biomarkers such as SDMA, may partially mediate the association between age and poorer outcomes in stroke patients treated with EVT.