Leucocyte rheology in the early stages of ischaemic stroke

Polymorphonuclear leukocytes in ischemic vascular disease

Over the last decade, an extensive amount of evidence has accumulated which implicates PMN in the etiology and pathophysiology of ischemic/thrombotic diseases. It has become apparent that PMN infiltration is not, as once thought, an innocent secondary phenomenon following ischemia. Rather, PMN are active participants in the pathophysiology of infarction, exacerbating the tissue damage. Since the development of means to achieve reperfusion after thrombosis, this phenomenon has become of critical importance. Many different approaches, targeted at prevention of PMN trapping in the capillaries of the ischemic, area, have been shown to effectively reduce the final infarct size, and will likely prove valuable adjuncts to reperfusion. However, perhaps the most significant aspect of the realization that PMN play a significant role in thrombotic disease may prove to be the potential for early intervention: Elevated PMN counts are predictive of ischemic events, and there is preliminary evidence that the elevated PMN count may be also associated with increased PMN activation, suggesting that research directed at the prophylactic use of anti-PMN agents might someday prove effective in reducing the incidence of MI and stroke.

Serial determinations of leukocyte aggregation in patients with ischemic stroke

The pattern of leukocyte aggregation and its possible relationship with the clinical outcome were evaluated in 35 untreated patients with acute cerebrovascular disease during each of the first three days of hospitalization. Although statistically significant differences were found when comparing patients and age and sex matched controls during any of the 3 days, a large overlapping of values was noted in each comparison. The overlapping was strongly reduced when the average 3-day value was compared. Similarly, when comparing subgroups of patients classified on the basis of their clinical status, the overlap of values observed during any of the 3 days dropped from 70% to 30% when considering the average 3-day levels of leukocyte aggregation. Furthermore, the level of correlation between leukocyte aggregation and size of cerebral infarction was better when considering the average 3-day value (p = .005) than the best single-day correlation (p = .01). These data suggest that the association between acute cerebrovascular ischemia and leukocyte rheology is better discovered when repeated evaluation of the latter are performed.

Leucocyte aggregation in acute cerebrovascular disease

We evaluated leucocyte aggregation in 26 patients with ischemic stroke and in 10 patients with transient ischemic attacks (TIA), previously untreated, within 24 h from the onset of symptoms. The evaluation was also performed in 30 healthy subjects matched for age and sex. Leucocyte aggregation was significantly higher in patients than in controls (p < 0.01 post hoc Tukey test). Within patients, those with stroke showed a significantly higher aggregation than those with TIA (p = 0.01 post hoc Tukey test). Moreover, stroke patients with the poorest outcome showed significantly higher values of leucocyte aggregation. These results indicate an involvement of leucocytes in cerebral ischemia and suggest that changes in their aggregability may play a role in the evolution of the disease.