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Neurology. 2017 Nov 21;89(21):2143-2150. doi: 10.1212/WNL.0000000000004677. Epub 2017 Oct 25.

Blood-brain barrier leakage increases with small vessel disease in acute ischemic stroke.

Author information

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.

PMID:
29070665
PMCID:
PMC5696647
DOI:
10.1212/WNL.0000000000004677
[Indexed for MEDLINE]
Free PMC Article

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