Integrating GFAP Improves Accuracy of Large Vessel Occlusion Detection in Acute Stroke Settings

A retrospective diagnostic accuracy study dubbed DETECT LVO found that integrating prehospital glial fibrillary acidic protein (GFAP) measurements with established large vessel occlusion (LVO) scores may improve diagnostic accuracy for detecting LVOs in patients with acute stroke. All told, this could enable direct transfers of patients with suspected LVOs to endovascular centers with reduced rates of misdiagnosis in the future.

Recently published in STROKE, this substudy was based off a 2022-2024 prospective German study, “DETECT” that evaluated the rapid intracerebral hemorrhage detection in acute stroke, measuring prehospital plasma GFAP levels on a point-of-care platform (i-STAT Alinity Abbott). Conversely, DETECT LVO retrospectively calculated LVO scores from paramedic protocols for 353 patients with a mean age of 74.6 years. The scores used in the study included Rapid Arterial Occlusion Evaluation, Field Assessment Stroke Triage for Emergency Destination, 3-Item Stroke Scale, Emergency Medical Stroke Assessment, and Cincinnati Prehospital Stroke Scale.

In DETECT LVO, LVOs were diagnosed with CT-angiography as follows: occlusion of the internal carotid artery, middle cerebral artery, and basilar artery. Diagnostic accuracy for LVO detection was determined using the area under the curve, sensitivity, specificity, positive predictive values, and negative predictive values.

Led by Love-Preet Kalra, MD, resident doctor in the neurology department at RKH Klinikm Ludwigsburg in Germany, the study found that among patients with ischemic stroke (n = 258), 101 experienced LVOs, most commonly in the middle cerebral artery (64.4%), followed by the internal carotid artery (23.8%) and basilar artery (11.9%). Overall, integrating prehospital GFAP measurements with established LVO scores significantly increased area under the curve (95% CI) and improved diagnostic accuracy across all scoring systems evaluated.

As for results, scores on Field Assessment Stroke Triage for Emergency Destination improved from 0.859 [SD, 0.818-0.893] to 0.899 [0.862-0.928] while the 3-Item Stroke Scale improved from 0.788 [0.741–0.829] to 0.865 [0.824–0.898]. Furthermore, scores on the Emergency Medical Stroke Assessment increased from 0.840 [0.796–0.875] to 0.870 [0.830–0.910] all while Cincinnati Prehospital Stroke Scale went up from 0.827 [0.784–0.865] to 0.862 [0.821–0.896]; P <0.001).

Read more: Neflamapimod Reduces Plasma GFAP in Dementia With Lewy Bodies, Showing Correlation With Clinical Improvement

There have been a number of prominent, recently published research regarding LVOs. A recent phase 2, investigator-initiated, randomized trial of patients with disabling LVO showed that use of semaglutide (Ozempic; Novo Nordisk) before and after endovascular thrombectomy (EVT) did not lead to improved functional recovery. Later, an exploratory analysis revealed more sustained neurological improvement among those who did not receive intravenous thrombolysis (IVT).²

Published in Nature, the findings indicated that semaglutide was safe and well-tolerated for this patient population and was also associated with a lower risk of intracranial hemorrhage (ICH). Otherwise known as the GALLOP trial, the study authors noted that these preliminary findings should be replicated in a larger phase 3 study.

In GALLOP, a prospective, open-label, blinded end point (PROBE) trial, 140 patients with disabling LVO undergoing EVT were randomly assigned to semaglutide therapy (0.5 mg subcutaneous [SC] before and 1 week after EVT) or standard therapy, using modified Rankin Scale (mRS) scores of 0-2 at 90 days as the primary outcome. During this time period, from August 2023 to July 2024, the primary outcome occurred in 56.5% (n = 39) of patients in the semaglutide group and in 54.9% (n = 39) of those in the standard therapy group, suggesting no between-group differences (adjusted RR, 1.05; 95% CI, 0.95-1.15; P = .37).

REFERENCES
1. Kalra L., Zylyftari S., Bos D., et al. Integrating GFAP Testing With Clinical Scores for Prehospital Large Vessel Occlusion Detection in Patients With Acute Stroke (DETECT LVO). STROKE. Published online January 13, 2026. Doi: 10.1161/STROKEAHA.125.052349
2. Wang H, Ko H, Leung TW, et al. Glucagon-like peptide-1 receptor agonist in large vessel occlusion treated by reperfusion therapy—a phase 2 randomized trial. Nat Commun. Published online December 19, 2025. doi:10.1038/s41467-025-66167-z