Abstract WP377: Metabolomic Profiling of Distal Blood during Thrombectomy Identifies 2,3-bisphosphoglycerate as a Biomarker of Ischemic Metabolism

Background: Although successful recanalization improves outcomes after mechanical thrombectomy for acute ischemic stroke, reliable prognostic markers beyond revascularization are lacking. Distal-to-occlusion blood may directly reflect the ischemic microenvironment, but its metabolic characteristics remain largely unexplored. Methods: Distal blood was obtained via microcatheter during thrombectomy for acute ischemic stroke (n=8) and during carotid artery stenting (n=4 controls). Targeted metabolomics was performed by liquid chromatography–mass spectrometry (LC–MS). Parallel sampling was conducted in a rat permanent middle cerebral artery occlusion (MCAO) model, with LC-MS analysis of ischemic brain tissue. In addition, a 4-vessel occlusion (4-VO) rat model was used to collect distal-to-occlusion blood, which was analyzed by Enzyme-linked immuno-sorbent assay (ELISA). Results: Principal component analysis (PCA) showed clear separation of ischemic distal samples from controls. 2,3-bisphosphoglycerate (2,3-BPG) levels were significantly elevated in thrombectomy patients’ distal blood (p