Serum vascular endothelial growth factor (VEGF) levels and neuroimaging markers in acute ischemic stroke: A cross-sectional analysis of hounsfield units, infarct volume, and clinical severity

Abstract

Background and aim: Vascular Endothelial Growth Factor (VEGF) is a key mediator of angiogenesis, neurogenesis, and blood–brain barrier (BBB) regulation in acute ischemic stroke (AIS). While elevated VEGF may represent a compensatory response, excessive expression can exacerbate tissue injury and cerebral edema. This study investigated the relationship between serum VEGF levels, Hounsfield units (HU), infarct volume, and neurological severity using the National Institutes of Health Stroke Scale (NIHSS). Methods: This observational, analytical, cross-sectional study was conducted at Dr. Wahidin Sudirohusodo Hospital and affiliated teaching hospitals in Makassar, Indonesia, from September 2025 until sample completion. Thirty-two AIS patients aged 18–65 years, with symptom onset <7 days, were included. Serum VEGF was measured using ELISA, HU values using region-of-interest (ROI) analysis, and infarct volume with the Broderick ABC/2 method on non-contrast CT. Demographics, vascular risk factors, stroke onset, and NIHSS were recorded at admission. Correlations were assessed with Spearman’s rho; p < 0.05 was considered significant. Results: The mean age was 56.7 ± 8.8 years, with 59.4% male. Most patients presented on day 1 (50%). Common risk factors were dyslipidemia (87.5%), hypertension (68.8%), and smoking (40.6%). Median values were VEGF 213 pg/ml, HU 19, infarct volume 15.4 cm³, and NIHSS 7. VEGF showed a moderate negative correlation with HU (r = –0.419, p = 0.016), a moderate positive correlation with infarct volume (r = 0.447, p = 0.010), and a weak positive correlation with NIHSS (r = 0.358, p = 0.044). Conclusions: Higher VEGF levels are associated with larger infarct volumes and lower HU values, suggesting greater tissue damage and BBB disruption. The weak correlation with severity highlights the influence of lesion site, collateral flow, and compensatory responses. VEGF may serve as a biomarker for tissue injury progression, supporting integrated imaging and clinical evaluation in early AIS management.

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