Abstract T MP33: Biomarkers of Ischemic Outcomes in Symptomatic Intracranial Stenosis (BIOSIS) - Preliminary Results
Background and Purpose: Intracranial atherosclerosis is a common cause of stroke. Although inflammatory biomarkers correlate with coronary artery disease, it is not known whether biomarkers of inflammation and endothelial repair are predictive of stroke in patients with intracranial atherosclerosis.The purpose of this study is to determine whether serum biomarkers of inflammation and the number of circulating progenitor cells (PCs) in patients with symptomatic intracranial stenosis are independent predictors of ischemic stroke.
Methods: Blood samples from patients in SAMMPRIS, a clinical trial comparing stenting plus medical treatment with medical treatment alone in patients with symptomatic intracranial stenosis, were obtained at study entry. Levels of inflammatory biomarkers (PAI-1, E-selectin, hsCRP, LpPLA2) and PCs were analyzed in relation to outcome events. Pre-specified outcomes of interest included stroke in the territory of the symptomatic stenotic artery and any ischemic stroke. The hazard ratio (HR) for each biomarker was determined in relation to outcome events using continuous and dichotomized values (median as cutpoint).
Results: There were 451 patients with baseline blood samples. Median follow-up was 32.4 months. In patients randomized to medical treatment only, dichotomized biomarker values revealed an association between elevated levels of PAI-1 [1.85 (0.95-3.62), p=0.07)], hsCRP [1.82 (0.96-3.44), p=0.06] and any ischemic stroke. PAI-1 was also associated with any ischemic stroke when analyzed as a continuous variable [1.2 (1.02-1.40), p=0.03]. None of the other inflammatory markers were associated with outcomes. Low levels of PCs enumerated as CD45med, CD34+/CD133+ dual positive cells also revealed a trend toward association with ischemic stroke in the territory of the symptomatic stenotic artery for the treatment groups combined [1.56 (0.93-2.63), p=0.09].
Conclusion: Elevated levels of PAI-1 and hsCRP are associated with risk of any ischemic stroke in patients with symptomatic intracranial stenosis treated with aggressive medical therapy. Low PC levels also appear to be associated with increased risk of recurrent stroke. As the SAMMPRIS trial reaches completion, multivariable analyses will be completed.
Author Disclosures: M.R. Frankel: Research Grant; Significant; NINDS. A. Quyyumi: None. Y. Zhao: None. Q. Long: Research Grant; Significant; NINDS. N. Le: None. E.K. Waller: None. M. Lynn: Research Grant; Significant; NINDS. J.F. Arenillas: None. B. Lane: Research Grant; Significant; NINDS. M. Chimowitz: Research Grant; Significant; NINDS. Other Research Support; Significant; Stryker Neurovascular, AstraZeneca.
- © 2014 by American Heart Association, Inc.