Open AccessPost-Stroke Blood-Brain Barrier Disruption and Poor Functional Outcome in Patients Receiving Thrombolytic Therapy
Author(s) -
Zurab Nadareishvili,
Alexis N Simpkins,
Emi Hitomi,
Dennys Reyes,
Richard Leigh
Publication year - 2019
Publication title -
cerebrovascular diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 104
eISSN - 1421-9786
pISSN - 1015-9770
DOI - 10.1159/000499666
Subject(s) - medicine , thrombolysis , stroke (engine) , perfusion scanning , blood–brain barrier , magnetic resonance imaging , modified rankin scale , inflammation , perfusion , cardiology , gastroenterology , ischemic stroke , ischemia , central nervous system , radiology , mechanical engineering , myocardial infarction , engineering
Background and Purpose: The role played by post-stroke inflammation after an ischemic event in limiting functional recovery remains unclear. One component of post-stroke inflammation is disruption of the blood-brain barrier (BBB). This study examines the relationship between post-stroke BBB disruption and functional outcome. Methods: Acute stroke patients treated with thrombolysis underwent magnetic resonance imaging scanning 24 h and 5 days after their initial event. BBB permeability maps were generated from perfusion weighted imaging. Average permeability was calculated in the affected hemisphere. Good functional outcome, defined as a modified Rankin score of 0 or 1, was compared with average permeability using logistic regression. Results: Of the 131 patients enrolled, 76 patients had the necessary data to perform the analysis at 24 h, and 58 patients had data for the 5-day assessment. Higher BBB permeability measured at 24 h (OR 0.57; 95% CI 0.33–0.99, p = 0.045) and at 5 days (OR 0.24; 95% CI 0.09–0.66, p = 0.005) was associated with worse functional outcome 1–3 months after the acute ischemic stroke. For every percentage increase in BBB disruption at 5 days, there was a 76% decrease in the chance of achieving a good functional outcome after stroke. Multivariate analysis found this to be independent of age, stroke volume, or clinical stroke severity. Conclusions: Post-stroke BBB disruption appears to be predictive of functional outcome irrespective of stroke size.