de la Riva Patricia, Rodríguez-Antigüedad Jon, Marta-Enguita Juan, Gómez Virginia, Arenaza Gorka, Gorostidi Ana, Díez Noemi, de Arce Ana, Garmendia Eñaut, Zumeta Eider, Larrea Jose Angel, Bergareche Alberto, López de Munain Arregui Adolfo
Neurology Department, Donostia University Hospital, San Sebastian, Spain; Ictus, Biogipuzkoa Health Research Institute, San Sebastian, Spain; Faculty of Health Sciences, Deusto University, San Sebastian, Spain; RICORS-ictus, National Institute of Health Carlos III; Neurosciences, University of the Basque Country, (UPV/EHU), San Sebastian, Spain.
Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J Stroke Cerebrovasc Dis. 2025 Oct;34(10):108412. doi: 10.1016/j.jstrokecerebrovasdis.2025.108412. Epub 2025 Aug 5.
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.
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.
年龄是接受血管内治疗（EVT）的缺血性卒中（IS）患者预后不良的公认预测指标。内皮在IS的病理生理学中起核心作用，其功能可通过多种方法进行评估。本研究旨在探讨接受EVT治疗的IS患者内皮功能障碍、年龄与临床结局之间的关系。方法：本研究纳入接受EVT治疗的IS患者。使用改良Rankin量表（mRS）评估90天预后。通过肱动脉超声测量的血流介导的血管舒张（FMD）以及使用超高效液相色谱-串联质谱法对EVT前动脉血清中精氨酸代谢物、高同型精氨酸（hArg）、对称二甲基精氨酸（SDMA）和不对称二甲基精氨酸（ADMA）进行定量分析来评估内皮功能。记录临床、影像学和EVT手术数据作为自变量。结果变量为二分法mRS<2时的良好功能结局。进行双变量、多变量和中介分析以探索关联。
共150例卒中患者纳入分析（中位年龄77岁，50.7%为女性）。老年患者内皮功能较差，表现为FMD值较低和精氨酸代谢物谱改变。他们在90天时的临床结局也较差。在这些代谢物中，SDMA是预后不良的独立预测指标（每增加0.1 μmol/l，OR = 1.343，p < 0.01）。此外，SDMA被确定为年龄与EVT后不良结局之间关系的中介因素。结论：循环生物标志物如SDMA所示的内皮功能障碍可能部分介导了接受EVT治疗的卒中患者年龄与较差结局之间的关联。
