Low caveolin‐1 levels and symptomatic intracranial haemorrhage risk in large‐vessel occlusive stroke patients after endovascular thrombectomy.

Background and purpose: Caveolin‐1 (Cav‐1) is reported to mediate blood–brain barrier integrity after ischaemic stroke. Our purpose was to assess the role of circulating Cav‐1 levels in predicting symptomatic intracranial haemorrhage (sICH) amongst ischaemic stroke patients after endovascular thrombectomy (EVT). Methods: Patients with large‐vessel occlusive stroke after EVT from two stroke centres were prospectively included. Serum Cav‐1 level was tested after admission. sICH was diagnosed according to the Heidelberg Bleeding Classification. Results: Of 325 patients (mean age 68.6 years; 207 men) included, 47 (14.5%) were diagnosed with sICH. Compared with patients without sICH, those with sICH had a lower concentration of Cav‐1. After adjusting for potential confounders, multivariate regression analysis demonstrated that the increased Cav‐1 level was associated with a lower sICH risk (odds ratio 0.055; 95% confidence interval 0.005–0.669; p = 0.038). Similar results were obtained when Cav‐1 levels were analysed as a categorical variable. Using a logistic regression model with restricted cubic splines, a linear and negative association of Cav‐1 concentration was found with sICH risk (p = 0.001 for linearity). Furthermore, the performance of the conventional risk factors model in predicting sICH was substantially improved after addition of the Cav‐1 levels (integrated discrimination index 2.7%, p = 0.002; net reclassification improvement 39.7%, p = 0.007). Conclusions: Our data demonstrate that decreased Cav‐1 levels are related to sICH after EVT. Incorporation of Cav‐1 into clinical decision‐making may help to identify patients at a high risk of sICH and warrants further consideration. [ABSTRACT FROM AUTHOR]