Soluble Adhesion Molecules in Brain Infarction - Adhesion Molecules - page 468

Fig. 3 Mean concentration of endothelial markers in isolated lacunar infarction, ischemic
leukoaraiosis and controls. Levels expressed as geometric mean (95% CI), Overall P and within-
group comparison (Schef e's post hoc test); ICAM-1, intercellular adhesion molecule 1; TM,
thrombomodulin; LA, leukoaraiosis; NS, not signii cant. (Modii ed from Hassan et al . 2003.)
SVD progression (Kawamura et al. 2006). In addition, high-sensitivity C-reactive
protein (hs-CRP) has received attention in recent years as a new risk factor for
stroke, which has value as predictor for future ischemic stroke. Recent studies
have found that hs-CRP levels are elevated in patients with SBI, suggesting that
the inl ammatory mechanism is associated not only with carotid atherosclerotic
disease but also with small-vessel or microvessel disease (Hoshi et al. 2005,
Ishikawa et al. 2007). On the other hand, in the Rotterdam Scan Study (van Dijk
et al. 2005), hs-CRP levels were observed to be signii cantly associated with WMLs
but not with lacunar infarction, which suggests that the degree of involvement
of inl ammatory markers may dif er between WMLs and lacunar infarction.
Furthermore, the results of a recent study on type 2 diabetic patients indicated that
elevated combination levels of ICAM-1 and hs-CRP were signii cantly increased
subsequent symptomatic ischemic stroke (Kanai et al. 2008) (Fig. 4) .
Prospects for Therapeutic Strategies
In order to prevent the incidence and recurrence of ischemic stroke, it is therefore
necessary to make vascular endothelium the target of therapy. For antiplatelet
agents, a secondary prevention in ischemic stroke has generally been established
but a primary prevention has not yet been observed. As large-scale clinical trials
have not yet been performed on the dif erent types of ischemic stroke, it will be