Background: 
Increased inflammatory and endothelial biomarker (EBM) activity may be evident in subjects with asymptomatic small vessel disease (SVD) and in patients with acute ischemic stroke (AIS) with pre-existing SVD. We hypothesize that EBM activity may be associated with SVD development, and progression of SVD (in presence of biomarkers) will be more aggressive following an AIS compared to controls.
Patients and Methods: 
We prospectively collected blood samples of patients who presented with AIS at Hamad General Hospital. All patients underwent 3T-MR imaging of the brain and analysis of five different EBM’s (MM9, IL-6, VEGF, E-selectin and P-selectin) at day 0, day-5 and day-30, performed by ELISA.
Results: 
80 patients with AIS and 24 controls underwent analysis. We found that patients with AIS had significantly higher levels of MMP-9 and IL-6 at stroke onset which decreased at 30 days, p=0.001. While VEGF, E-Selectin and P-Selectin levels showed persistently higher levels from onset till day-30 p=0.001. The expression of these EBM over time (day 0, day-5 and day-30) were different between patients with or without SVD. Patients with SVD showed significantly higher levels of EBM at stroke onset compared to no-SVD patients and the levels decreased more significantly during the 30 days following the acute event. 
Results: 
80 patients with AIS and 24 controls underwent analysis. We found that patients with AIS had significantly higher levels of MMP-9 and IL-6 at stroke onset which decreased at 30 days, p=0.001. While VEGF, E-Selectin and P-Selectin levels showed persistently higher levels from onset till day-30 p=0.001. The expression of these EBM over time (day 0, day-5 and day-30) were different between patients with or without SVD. Patients with SVD showed significantly higher levels of EBM at stroke onset compared to no-SVD patients and the levels decreased more significantly during the 30 days following the acute event.
Conclusions:
There are differences in biomarker signatures in AIS patients with SVD when compared to no-SVD. SVD patients have significantly higher levels of EBM at stroke onset, and the levels decreased more significantly over time following event, suggesting more severe endothelial activation and injury in patients with SVD.

RELATIONSHIP OF INFLAMMATORY AND ENDOTHELIAL BIOMARKERS WITH PRE-EXISTING SMALL VESSEL DISEASE IN PATIENTS PRESENTING WITH ACUTE STROKE