1405 - Lipoprotein A (Lp(a)) as a Stroke Predictor in an Ischemic Stroke Patient

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AC

Ai Mei Chua, MD

Resident Physician
Emory University
Atlanta, Georgia, United States

Co-Author(s)

AD

Andrew Dennison, MD

Medical Director of Acquired Brain Injury Program
Shepherd Center
Atlanta, Georgia, United States

Submitter(s)

AC

Ai mei Chua, MD

Emory University
Atlanta, Georgia, United States

Case Diagnosis: Complete occlusion of right vertebral artery, distal basilar artery, and bilateral proximal posterior cerebral arteries.

Case Description: 46-year-old female with history of type 2 diabetes mellitis, hypertension, hyperlipidemia, and previous left posterior inferior cerebellar artery (PICA) stroke in 2020 who presented in June 2024 with disconjugate gaze and seizure-like activity. Found to have the above finding on imaging. Patient underwent mechanical thrombectomy with TICI 3 reperfusion. In July 2024, new infarcts were found in the right caudate nucleus and posterior right corpus coliseum splenium. Stroke labs revealed markedly elevated Lp(a) level, which was noted to be 242mg/dL (normal range: 2-30); mildly elevated triglyceride; and elevated HgbA1c, although improved from prior baseline; but normal cholesterol low density lipoprotein (LDL) and high density lipoprotein (HDL).

Discussions: Standard lipid panel during a stroke work up often includes HDL, LDL, triglyceride, and total cholesterol. Lp(a) is often excluded as part of the work up. It is worth noting that in this patient with multiple lifetime stroke occurrences, Lp(a) is the single most significant finding. This marker is a lipoprotein that binds to LDL, calcium, and other components into atherosclerotic plaques on the walls of arteries. Recent studies have theorized that this marker plays a role in speeding up development of atherosclerosis and as a predictive marker for individuals at risk for an ischemic stroke. It is difficult, however, to completely isolate Lp(a) as the sole contributing factor with other confounding factors at play including mildly elevated triglycerides and existing diabetes mellitus.

Conclusions: Lp(a) should be included in the standard lipid panel for a stroke work up. Further studies to investigate the relationship between Lp(a) and ischemic stroke can then be carried out with this implementation.