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Ischemic Stroke
Original research
Increased blood-brain barrier permeability in contralateral hemisphere predicts worse outcome in acute ischemic stroke after reperfusion therapy
  1. Chang Liu,
  2. Shenqiang Yan,
  3. Ruiting Zhang,
  4. Zhicai Chen,
  5. Feina Shi,
  6. Ying Zhou,
  7. Meixia Zhang,
  8. Min Lou
  1. The Second Affiliated Hospital of Zhejiang University, School of Medicine, Neurology, Hangzhou, Zhejiang, China
  1. Correspondence to Professor Min Lou, Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou,310009, China; lm99{at}zju.edu.cn

Abstract

Aims We sought to investigate the risk factors of blood-brain barrier (BBB) disruption, and its potential impact on 90-day clinical outcome in acute ischemic stroke (AIS) patients after reperfusion therapy.

Methods Consecutive acute anterior circulation AIS patients imaged with computed tomographic perfusion (CTP) before reperfusion therapy were included. Tmax >6 s was used for the volumetric measurement of the hypoperfusion area. BBB permeability (BBBP) was calculated as the average relative permeability-surface area product (rPS) within the hypoperfusion region (rPShypo-i) and its contralateral mirror region (rPShypo-c) on CTP-derived PS color maps. Modified Rankin Scale (mRS) score was obtained at 90-day post-stroke.

Results A total of 187 patients were included, among whom the median age was 73 (61–80) years and 76 (40.6%) were women. Median baseline NIHSS score was 12 (7– 16). Ninety-eight (52.4%) patients had mRS score >2. Increased rPShypo-i and rPShypo-c were both independently associated with males and large infarct volume. The increased rPShypo-i was also independently associated with a history of atrial fibrillation and high NIHSS score. Multivariable analysis showed higher rPShypo-c was independently associated with higher mRS (OR: 1.064, 95% CI 1.011 to 1.121; P=0.018).

Conclusion BBBP in both the hypoperfusion region and its contralateral mirror region are associated with stroke severity, but only increased BBBP in the contralateral mirror hypoperfusion region relates to worse outcome after reperfusion therapy.

  • ct perfusion
  • stroke
  • thrombolysis
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2017-013663

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    Footnotes

    • Contributors CL: study design, data acquisition, data analysis and interpretation of data, drafting/revising the manuscript for intellectual content. ML: study concept/design, study supervision, interpretation of data, revising the manuscript for intellectual content. SY: study design, data analysis and interpretation of data, revising the manuscript for intellectual content. RZ: data acquisition, interpretation of data, revising the manuscript for intellectual content. ZC: data acquisition, revising the manuscript for intellectual content. FS: data acquisition, revising the manuscript for intellectual content. YZ: data acquisition, revising the manuscript for intellectual content. MZ: data acquisition, revising the manuscript for intellectual content.

    • Funding This study was funded by National Natural Science Foundation of China.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The human ethics committee of the second affiliated hospital of Zhejiang University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data available.