Sphingolipid Profiling Identifies Large Vessel Occlusions At Early Time Points: Results Of The Aspire-Stroke Study

Background: Rapid identification and transport of patients with large vessel occlusions (LVO) to endovascular-capable hospitals has become increasingly important. We previously demonstrated that brain-specific sphingolipids (SLs) serve as useful plasma markers of brain injury. Here, we test and validate SL biomarkers to differentiate LVO from non-LVO acute ischemic stroke (AIS) and stroke mimics. Methods: We enrolled consecutive patients with symptoms concerning for AIS and performed SL profiling using HPLC-MS/MS on blood samples obtained at hospital arrival. MS data were aligned and automated peak picking was performed using XCMS, and SLs were identified by exact mass. A classification method using SL plasma concentrations was created using step-wise logistic regression in a derivation arm, and then tested in an independent validation arm. Results: Among 184 patients with AIS or AIS-mimics, 84 (46%) were female and age was 73 years (IQR 63-84). 81 (44%) were diagnosed with AIS, 32 (17%) with TIA, and 71 ...