ABSTRACT NUMBER: ESOC2026LB58 PREDICTION OF ACUTE ISCHEMIC STROKE WITH LARGE VESSEL OCCLUSION WITH 5-HYDROXYMETHYLCYTOSINE BIOMARKERS

Abstract Background and aims Early identification of patients with acute ischemic stroke (AIS), especially AIS with large vessel occlusion (LVO-AIS), can assist with patient triage and implementation of reperfusion therapy. In this study, we investigated the potential of the 5-hydroxymethylcytosine (5hmC) modification of extracellular vesicle deoxyribonucleic acid (evDNA) to distinguish LVO-AIS from healthy controls (HC) and intracranial hemorrhage (ICH). Methods Early identification of patients with acute ischemic stroke (AIS), especially AIS with large vessel occlusion (LVO-AIS), can assist with patient triage and implementation of reperfusion therapy. In this study, we investigated the potential of the 5-hydroxymethylcytosine (5hmC) modification of extracellular vesicle deoxyribonucleic acid (evDNA) to distinguish LVO-AIS from healthy controls (HC) and intracranial hemorrhage (ICH). Results From May 2018 to December 2022, 113 LVO-AIS patients, 48 ICH patients, and 100 HC were enrolled. The prediction model effectively distinguished LVO-AIS patients from healthy controls using 5hmC markers (AUC = 0.975, 95% CI, 0.953-0.996), with a sensitivity of 94.4% and a specificity of 92.5%. Additionally, we found that 5hmC markers showed good performance for distinguishing LVO-AIS not only from healthy control (AUC = 0.913, 95%CI, 0.843-0.983), but from ICH patients (0.909, 95%CI, 0.853-0.965). Conclusions This study suggests that 5hmC markers derived from evDNA may serve as potential epigenetic biomarkers for diagnosing LVO-AIS in non-stroke individuals and, most importantly, hemorrhagic stroke. These findings require further confirmation, given the limited sample size and the wide time window. Conflict of interest Figure 1 - belongs to Methods Figure 2 - belongs to Results