Blood-brain barrier leakage increases with small vessel disease in acute ischemic stroke
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Blood-brain barrier leakage increases with small vessel disease in acute ischemic stroke. / Arba, Francesco; Leigh, Richard; Inzitari, Domenico; Warach, Steven J; Luby, Marie; Lees, Kennedy R; STIR/VISTA Imaging Collaboration.
In: NEUROLOGY, Vol. 89, No. 21, 21.11.2017, p. 2143-2150.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Blood-brain barrier leakage increases with small vessel disease in acute ischemic stroke
AU - Arba, Francesco
AU - Leigh, Richard
AU - Inzitari, Domenico
AU - Warach, Steven J
AU - Luby, Marie
AU - Lees, Kennedy R
AU - STIR/VISTA Imaging Collaboration
N1 - © 2017 American Academy of Neurology.
PY - 2017/11/21
Y1 - 2017/11/21
N2 - 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.
AB - 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.
KW - Aged
KW - Aged, 80 and over
KW - Analysis of Variance
KW - Blood-Brain Barrier
KW - Brain Ischemia
KW - Cerebral Small Vessel Diseases
KW - Female
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Stroke
KW - Tomography, X-Ray Computed
KW - Journal Article
U2 - 10.1212/WNL.0000000000004677
DO - 10.1212/WNL.0000000000004677
M3 - SCORING: Journal article
C2 - 29070665
VL - 89
SP - 2143
EP - 2150
JO - NEUROLOGY
JF - NEUROLOGY
SN - 0028-3878
IS - 21
ER -
