In a previous study, McLouth et al. found worsened functional outcomes based on NIHSS in Appalachian patients associated with several plasma proteins (ANG, LIF R, IL15RA, CXCL9, CXCL10, IL-13, IL-6, and THBS4) at the time of MT, despite no significant differences in risk factors for stroke between Appalachian and non-Appalachian stroke patients tested (McLouth et al., 2024). This evidence concerns the gene THBS4 and Stroke.