Francesco Arba1, Richard Leigh2, Domenico Inzitari2, Steven J Warach2, Marie Luby2, Kennedy R Lees2. 1. From the NEUROFARBA Department (F.A., D.I.), University of Florence, Italy; National Institute of Neurological Disorders and Stroke (R.L., M.L.), NIH, Bethesda, MD; Institute of Cardiovascular and Medical Sciences (F.A.), Queen Elizabeth University Hospital, Glasgow, UK; Department of Neurology (S.J.W.), Dell Medical School, University of Texas at Austin; and Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK. francesco.arba@unifi.it. 2. From the NEUROFARBA Department (F.A., D.I.), University of Florence, Italy; National Institute of Neurological Disorders and Stroke (R.L., M.L.), NIH, Bethesda, MD; Institute of Cardiovascular and Medical Sciences (F.A.), Queen Elizabeth University Hospital, Glasgow, UK; Department of Neurology (S.J.W.), Dell Medical School, University of Texas at Austin; and Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK.
Abstract
OBJECTIVE: In patients with acute ischemic stroke, we aimed to investigate the relation between preexisting small vessel disease (SVD) and the amount of blood-brain barrier (BBB) leakage in ischemic and nonischemic area before IV thrombolysis. METHODS: We retrospectively accessed anonymous patient-level data from the Stroke Imaging Repository and the Virtual International Stroke Trials Archive resources and included patients treated with IV thrombolysis with pretreatment MRI. We rated SVD features using validated qualitative magnetic resonance (MR) scales. Leakage of BBB was assessed with postprocessing of perfusion-weighted images. We evaluated associations between SVD features (individually and summed in a global SVD score) and BBB leakage using linear regression analysis, adjusting for major clinical confounders. RESULTS: A total of 212 patients, mean age (±SD) 69.5 years (±16.1), 102 (48%) male, had available MR before IV thrombolysis. Evidence of BBB leakage was present in 175 (80%) and 205 (94%) patients in the ischemic and nonischemic area, respectively. Lacunar infarcts (β = 0.17, p = 0.042) were associated with BBB leakage in the ischemic area, and brain atrophy was associated with BBB leakage in both ischemic (β = 0.20, p = 0.026) and nonischemic (β = 0.27, p = 0.001) areas. Increasing SVD grade was independently associated with BBB leakage in both ischemic (β = 0.26, p = 0.007) and nonischemic (β = 0.27, p = 0.003) area. CONCLUSIONS: Global SVD burden is associated with increased BBB leakage in both acutely ischemic and nonischemic area. Our results support that SVD score has construct validity, and confirm a relation between SVD and BBB disruption also in patients with acute stroke.
OBJECTIVE: In patients with acute ischemic stroke, we aimed to investigate the relation between preexisting small vessel disease (SVD) and the amount of blood-brain barrier (BBB) leakage in ischemic and nonischemic area before IV thrombolysis. METHODS: We retrospectively accessed anonymous patient-level data from the Stroke Imaging Repository and the Virtual International Stroke Trials Archive resources and included patients treated with IV thrombolysis with pretreatment MRI. We rated SVD features using validated qualitative magnetic resonance (MR) scales. Leakage of BBB was assessed with postprocessing of perfusion-weighted images. We evaluated associations between SVD features (individually and summed in a global SVD score) and BBB leakage using linear regression analysis, adjusting for major clinical confounders. RESULTS: A total of 212 patients, mean age (±SD) 69.5 years (±16.1), 102 (48%) male, had available MR before IV thrombolysis. Evidence of BBB leakage was present in 175 (80%) and 205 (94%) patients in the ischemic and nonischemic area, respectively. Lacunar infarcts (β = 0.17, p = 0.042) were associated with BBB leakage in the ischemic area, and brain atrophy was associated with BBB leakage in both ischemic (β = 0.20, p = 0.026) and nonischemic (β = 0.27, p = 0.001) areas. Increasing SVD grade was independently associated with BBB leakage in both ischemic (β = 0.26, p = 0.007) and nonischemic (β = 0.27, p = 0.003) area. CONCLUSIONS: Global SVD burden is associated with increased BBB leakage in both acutely ischemic and nonischemic area. Our results support that SVD score has construct validity, and confirm a relation between SVD and BBB disruption also in patients with acute stroke.
Authors: Shreyansh Shah; Marie Luby; Karen Poole; Teresa Morella; Elizabeth Keller; Richard T Benson; John K Lynch; Zurab Nadareishvili; Amie W Hsia Journal: Neurology Date: 2015-05-13 Impact factor: 9.910
Authors: Alida A Gouw; Alexandra Seewann; Wiesje M van der Flier; Frederik Barkhof; Annemieke M Rozemuller; Philip Scheltens; Jeroen J G Geurts Journal: J Neurol Neurosurg Psychiatry Date: 2010-10-09 Impact factor: 10.154
Authors: Lawrence L Latour; Dong-Wha Kang; Mustapha A Ezzeddine; Julio A Chalela; Steven Warach Journal: Ann Neurol Date: 2004-10 Impact factor: 10.422
Authors: Richard Leigh; Søren Christensen; Bruce C V Campbell; Michael P Marks; Gregory W Albers; Maarten G Lansberg Journal: Neurology Date: 2016-06-17 Impact factor: 9.910
Authors: Francesco Arba; Benedetta Piccardi; Vanessa Palumbo; Betti Giusti; Patrizia Nencini; Anna Maria Gori; Alice Sereni; Mascia Nesi; Giovanni Pracucci; Giorgio Bono; Paolo Bovi; Enrico Fainardi; Domenico Consoli; Antonia Nucera; Francesca Massaro; Giovanni Orlandi; Francesco Perini; Rossana Tassi; Maria Sessa; Danilo Toni; Rosanna Abbate; Domenico Inzitari Journal: Transl Stroke Res Date: 2018-04-23 Impact factor: 6.829
Authors: Rosalind Brown; Helene Benveniste; Sandra E Black; Serge Charpak; Martin Dichgans; Anne Joutel; Maiken Nedergaard; Kenneth J Smith; Berislav V Zlokovic; Joanna M Wardlaw Journal: Cardiovasc Res Date: 2018-09-01 Impact factor: 10.787
Authors: Marlies P Noz; Annemieke Ter Telgte; Kim Wiegertjes; Anil M Tuladhar; Charlotte Kaffa; Simone Kersten; Siroon Bekkering; Charlotte D C C van der Heijden; Alexander Hoischen; Leo A B Joosten; Mihai G Netea; Marco Duering; Frank-Erik de Leeuw; Niels P Riksen Journal: Front Cardiovasc Med Date: 2021-05-13
Authors: B E Dewey; X Xu; L Knutsson; A Jog; J L Prince; P B Barker; P C M van Zijl; R Leigh; P Nyquist Journal: AJNR Am J Neuroradiol Date: 2021-06-03 Impact factor: 4.966