ABSTRACT NUMBER: ESOC2026A1606 VON WILLEBRAND FACTOR AS A PROGNOSTIC BIOMARKER IN ISCHEMIC STROKE

Abstract Background and aims Von Willebrand factor (vWF) is a key mediator of thromboinflammatory processes and has been implicated in resistance to acute revascularization therapies —intravenous thrombolysis (IVT) and mechanical thrombectomy (MT)—in acute ischemic stroke, compromising tissue reperfusion and functional outcomes. The aim is to assess the prognostic value of plasma vWF levels measured prior to any effective endovascular recanalization, and to explore mechanistic correlates that might underlie any observed association. Methods We retrospectively analyzed a cohort of 295 patients with carotid-territory large-vessel occlusion acute ischemic stroke treated with MT ± IVT. Plasma vWF level was measured at arterial puncture at the start of MT. The association between vWF level and favorable 90-day outcome (mRS 0–2) was examined using univariable and multivariable logistic regression adjusting for age, baseline clinico-radiological severity, and neutrophil count. To assess mechanistic links, we tested correlations between vWF and imaging markers of baseline severity, blood–brain barrier disruption, hemorrhagic transformation, and procedural difficulty. Results Higher vWF levels were independently associated with a lower odds of favorable 90-day mRS in patients without prior IVT recanalization (p = 0.03). This association was not observed in the subgroup that received IVT (p = 0.05). Among all radiological/procedural markers, only a higher number of thrombectomy passes correlated with higher vWF levels (p = 0.04). Conclusions When measured before effective recanalization, plasma vWF appears to be an independent prognostic biomarker. A plausible explanation is its involvement in revascularization resistance, reflected by the greater number of MT passes required in patients with higher vWF. Conflict of interest Nothing to disclose