Chang Liu1, Sheng Zhang1, Shenqiang Yan1, Ruiting Zhang1, Feina Shi1, Xinfa Ding2, Mark Parsons3, Min Lou4. 1. Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China. 2. Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China. 3. Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia. 4. Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China. loumingxc@vip.sina.com.
Abstract
OBJECTIVES: We aimed to detect early changes of the blood-brain barrier permeability (BBBP) in acute ischaemic stroke (AIS), with or without reperfusion, and find out whether BBBP can predict clinical outcomes. METHODS: Consecutive AIS patients imaged with computed tomographic perfusion (CTP) before and 24 h after treatment were included. The relative permeability-surface area product (rPS) was calculated within the hypoperfused region (rPShypo-i), non-hypoperfused region of ischaemic hemisphere (rPSnonhypo-i) and their contralateral mirror regions (rPShypo-c and rPSnonhypo-c). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome. RESULTS: Fifty-six patients were included in the analysis, median age was 76 (IQR 62-81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPShypo-i, rPSnonhypo-i and rPShypo-c all decreased significantly. The decreases in rPShypo-i and rPShypo-c were larger in the reperfusion group than non-reperfusion group. The rPShypo-i at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018-1.256; P = 0.022). CONCLUSION: Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome. KEY POINTS: • Early disruption of blood-brain barrier (BBB) in stroke is reversible after treatment. • The reversibility of BBB permeability is associated with reperfusion. • Unfavourable outcome is associated with BBB permeability at 24 h after treatment. • Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.
OBJECTIVES: We aimed to detect early changes of the blood-brain barrier permeability (BBBP) in acute ischaemic stroke (AIS), with or without reperfusion, and find out whether BBBP can predict clinical outcomes. METHODS: Consecutive AIS patients imaged with computed tomographic perfusion (CTP) before and 24 h after treatment were included. The relative permeability-surface area product (rPS) was calculated within the hypoperfused region (rPShypo-i), non-hypoperfused region of ischaemic hemisphere (rPSnonhypo-i) and their contralateral mirror regions (rPShypo-c and rPSnonhypo-c). The changes of rPS were analysed using analysis of variance (ANOVA) with repeated measures. Logistic regression was used to identify independent predictors of unfavourable outcome. RESULTS: Fifty-six patients were included in the analysis, median age was 76 (IQR 62-81) years and 28 (50%) were female. From baseline to 24 h after treatment, rPShypo-i, rPSnonhypo-i and rPShypo-c all decreased significantly. The decreases in rPShypo-i and rPShypo-c were larger in the reperfusion group than non-reperfusion group. The rPShypo-i at follow-up was a predictor for unfavourable outcome (OR 1.131; 95% CI 1.018-1.256; P = 0.022). CONCLUSION: Early disruption of BBB in AIS is reversible, particularly when greater reperfusion is achieved. Elevated BBBP at 24 h after treatment, not the pretreatment BBBP, predicts unfavourable outcome. KEY POINTS: • Early disruption of blood-brain barrier (BBB) in stroke is reversible after treatment. • The reversibility of BBB permeability is associated with reperfusion. • Unfavourable outcome is associated with BBB permeability at 24 h after treatment. • Contralateral non-ischaemic hemisphere is not 'normal' during an acute stroke.
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