Systemic inflammation and endothelial dysfunction influence the risk and severity of hemorrhagic transformation after endovascular treatment for acute ischemic stroke

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dc.contributor.authorÁlvarez Agoués, Kattalin
dc.contributor.authorRiva Juez, Patricia de la
dc.contributor.authorRodríguez-Antigüedad Muñoz, Jon
dc.contributor.authorGómez, Virginia
dc.contributor.authorArenaza Choperena, Gorka
dc.contributor.authorGorostidi, Ana
dc.contributor.authorDíez, Noemí
dc.contributor.authorArce Borda, Ana de
dc.contributor.authorMartínez Zabaleta, María Teresa
dc.contributor.authorGarmendia, Eñaut
dc.contributor.authorLüttich, Alex
dc.contributor.authorAnabitarte González, Maier
dc.contributor.authorLarrea Peña, José Ángel
dc.contributor.authorBergareche, A
dc.contributor.authorLópez de Munain Arregui, Adolfo
dc.contributor.authorMarta Enguita, Juan
dc.date.accessioned2026-09-09T18:18:56Z
dc.date.available2026-09-09T18:18:56Z
dc.date.issued2026
dc.date.updated2026-09-09T18:18:56Z
dc.description.abstractBackground – Hemorrhagic transformation (HT) is a frequent and serious complication, occurring in up to 40% of cases after endovascular treatment (EVT) for acute ischemic stroke (AIS). Inflammation has been increasingly recognized as a key factor influencing both stroke pathophysiology and post-treatment complications (such as HT) interacting with endothelial dysfunction to exacerbate vascular injury after EVT. The objective of this study is to evaluate whether systemic inflammatory status predicts HT in AIS patients, and its relationship with endothelial biomarkers in the setting of this complication. Methods – We retrospectively reviewed a prospective cohort of 229 AIS patients treated with EVT. Demographic, clinical, imaging, and laboratory data were collected. Inflammatory markers included white blood cell subsets and indices such as neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Endothelial function was assessed by flow-mediated dilation (FMD) and circulating homoarginine (HArg), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). The main outcome was radiological or symptomatic HT, classified according to ECASS criteria. Results – HT was observed in 92 patients (40.2%), of whom 35 (36.1% of HT and 15.3% of the total) were symptomatic. In multivariate analysis, independent predictors of HT included higher NIHSS at admission, higher plasma glucose at admission, the use of non-aspiration devices, lower pre-recanalization lymphocyte count, higher pre-recanalization SII and higher NLR levels. Among endothelial function markers, HArg correlated with inflammatory markers, ANC (r = −0.2) and WBC (r = −0.19), and was associated to PH and symptomatic HT, but not with any radiologic HT after AIS. Conclusion – An altered inflammatory status prior to EVT in AIS patients is associated with an increased risk of developing HT after EVT. Additionally, endothelial dysfunction could participate in the more aggressive forms of this complication.en
dc.description.sponsorshipThis work was supported by funding grants from the Basque Government Department of Healthen
dc.identifier.citationÁlvarez-Agoues, K., de la Riva, P., Rodríguez-Antigüedad, J., Gomez, V., Arenaza-Choperena, G., Gorostidi, A., Díez, N., de Arce, A., Martínez-Zabaleta, M., Garmendia, E., Lüttich, A., Anabitarte, M., Larrea, J. A., Bergareche, A., Lopez de Munain, A., & Marta-Enguita, J. (2026). Systemic inflammation and endothelial dysfunction influence the risk and severity of hemorrhagic transformation after endovascular treatment for acute ischemic stroke. Frontiers in Neurology, 17. https://doi.org/10.3389/FNEUR.2026.1913218
dc.identifier.doi10.3389/FNEUR.2026.1913218
dc.identifier.eissn1664-2295
dc.identifier.urihttps://hdl.handle.net/20.500.14454/6607
dc.language.isoeng
dc.publisherFrontiers Media SA
dc.rights© 2026 Álvarez-Agoues, de la Riva, Rodríguez-Antigüedad, Gomez, Arenaza-Choperena, Gorostidi, Díez, de Arce, Martínez-Zabaleta, Garmendia, Lüttich, Anabitarte, Larrea, Bergareche, LÓpez de Munain and Marta-Enguita.
dc.subject.otherAcute ischemic stroke (AIS)
dc.subject.otherBiomarkers
dc.subject.otherEndothelial dysfunction
dc.subject.otherEndovascular treatment (EVT)
dc.subject.otherFlow-mediated dilation (FMD)
dc.subject.otherHemorrhagic transformation (HT)
dc.subject.otherHomoarginine (Harg)
dc.subject.otherNeutrophil-to-lymphocyte ratio (NLR)
dc.titleSystemic inflammation and endothelial dysfunction influence the risk and severity of hemorrhagic transformation after endovascular treatment for acute ischemic strokeen
dc.typejournal article
dcterms.accessRightsopen access
oaire.citation.titleFrontiers in Neurology
oaire.citation.volume17
oaire.licenseConditionhttps://creativecommons.org/licenses/by/4.0/
oaire.versionVoR
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