Changes in the “von Willebrand factor—metalloprotease ADAMTS13 system” in patients with ischemic stroke undergoing mechanical thromboextraction depending on the severity of neurological deficiency and the functional outcome

Introduction. The high prevalence of acute cardiovascular diseases and the significant mortality associated with them sustain ongoing interest in the mechanisms of thrombus formation and the factors preceding thrombosis, particularly in the arterial bed.

Aim: to assess changes in the quantitative and qualitative characteristics of the metalloprotease ADAMTS13 and von Willebrand factor (vWF) antigen in patients with ischemic stroke (IS) who underwent mechanical thrombectomy, depending on the neurological deficit and functional outcome of the disease.

Materials and methods. The study included 52 patients aged 36 –95 years (median age 72 years) who received inpatient treatment for IS, in whom cerebral angiography revealed thrombosis of the intracranial segments of the brachiocephalic arteries followed by mechanical thrombectomy. All patients were tested for vWF antigen, ADAMTS13 activity, ADAMTS13 antigen, and antibodies to ADAMTS13. Venous blood samples for the study were obtained upon hospital admission, 24 hours, and 120 hours after hospitalization.

Results. The vWF:Ag values in the group of IS patients with a fatal outcome upon admission exceeded the upper limit of the reference interval but did not statistically differ from the vWF:Ag values in the group of IS patients with a favorable outcome (197.7 % [139.8–255.6] vs. 142.1 % [109.2–195.5], p = 0.071). The vWF:Ag levels at 24 hours and 120 hours in patients with a fatal hospitalization outcome were significantly higher compared to those in recovered patients (236.1 % [201.6–288.6] and 345.6 % [331.7–382.1] vs. 185.2 % [135.1–205.8] and 198.4 % [149.9–256.4]; p = 0.005 and p = 0.001, respectively). In the group of patients with severe IS, the median vWF:Ag level at 120 hours after admission was significantly higher compared to that in the group of patients with mild and moderate IS (291.7 % [199.7–363.2] vs. 187.4 % [130.5–250.9], p = 0.011). No significant differences in the medians of quantitative and qualitative characteristics of the ADAMTS13 metalloprotease were found between groups formed based on either disease outcome or severity of neurological deficit (p > 0.05).

Conclusion. Elevated vWF:Ag in patients with an unfavorable outcome of IS indicates endothelial dysfunction and the potential realization of a prothrombotic state. Since the fatal outcome was accompanied by infectious complications, the increase in vWF:Ag should be considered as a reaction of an acute-phase marker. No significant differences in the quantitative and qualitative indicators of ADAMTS13 were found between patient groups with different functional outcomes and neurological deficits.

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