The value of plasma fibrillin-1 level in patients with spontaneous cerebral artery dissection

Objective: To explore the value of plasma fibrillin-1 levels in patients with spontaneous cerebral artery dissection (sCeAD).

Methods: A single-center prospective cohort of 99 consecutive patients with sCeAD between February 2013 and December 2015 were age and sex matched with 115 patients with non-sCeAD ischemic stroke and 20 healthy participants undergoing routine physical examination. The plasma fibrillin-1 level was measured with ELISA and compared among the 3 groups. The associations of fibrillin-1 with site, acuity, and severity of dissection, as well as clinical and radiographic prognosis of patients, were analyzed.

Results: One hundred nine plasma samples from 99 patients with sCeAD, 115 from disease control patients, and 20 from healthy participants were collected. The plasma fibrillin-1 level of the dissection group (mean 85.56 ng/mL [95% confidence interval 81.53-89.59]) was higher than that of non-sCeAD ischemic stroke group (77.13 ng/mL [73.64-80.63], p = 0.015) or healthy controls (73.04 ng/mL [65.94-80.13], p = 0.029). Such differences were most prominent in the acute stage (97.64 ng/mL [91.64-103.64], 74.39 ng/mL [68.95-79.84], and 73.04 ng/mL [65.95-80.13], respectively). A cutoff value of 88.455 ng/mL was determined to differentiate acute dissection from nondissection stroke with a sensitivity of 0.778 and a specificity of 0.800. Higher fibrillin-1 level was detected in patients with more severe dissection radiographically (p < 0.001), while patients with lower fibrillin-1 concentration at baseline achieved better morphologic recovery on follow-up imaging tests (p = 0.003).

Conclusion: Plasma fibrillin-1 is a promising biomarker for aiding the diagnosis of acute sCeAD and may have potential value in lesion severity grading and radiographic prognosis prediction.

Classification of evidence: This study provides Class III evidence that patients with sCeAD have significantly higher levels of plasma fibrillin-1 than patients with ischemic stroke attributable to a cause other than sCeAD.