Endothelial dysfunction indicators and hemorheological properties in acute ischemic stroke

Abstract

We evaluated endothelial dysfunction and hemorheological indicatorsin acute ischemic stroke. The hemorheological indicators(blood viscosity, plasma viscosity, hematocrit, erythrocyte aggregationand deformability, fibrinogen concentration) were assessedthree times: within the first 12 hours of the onset of symptomsand on day 35 and day 1820 after hospitalization; theendothelial dysfunction indicators were examined on day 1517 using a cuff test. Patients in the acute phase of ischemic strokehad pronounced changes in the hemorheological indicators thatcould be characterized as high blood viscosity syndrome. Forexample, we observed increased platelet aggregation that playsa key role in the blood viscosity value in blood vessels with lowshear rates. We also observed reduced erythrocyte deformabilityat high shear rates. After treatment, patients had positive clinicaldynamics according to neurological scales. Dynamics of thehemorheological indicators was as follows: erythrocyte aggregationdecreased; blood viscosity tended to reduce; however, erythrocytedeformability tended to worsen. Therefore, the pathologicalchanges in elastic properties of the erythrocyte membranes instroke are not corrected by ongoing standard therapy. Assessmentof the endothelial functional activity revealed that stroke patientshad a decreased brachial artery response associated with reactivehyperemia and an increased response to the nitroglycerin test. The study demonstrated that treated patients with ischemicstroke had endothelial functional activity changes that manifestedas a statistically significant increase in the endothelial dysfunctionindex. We concluded that the approach to stroke treatmentrequires complex pharmacological correction, in particularby means with the proven hemorheological activity.

Keywords

• ischemic stroke
• acute phase
• hemorheological indicators
• endothelial dysfunction