Blood–brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke

Khatri, Rakesh; McKinney, Alexander M.; Swenson, Barbara; Janardhan, Vallabh

doi:10.1212/wnl.0b013e3182697e70

Cited by 394 publications

(290 citation statements)

References 24 publications

(33 reference statements)

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“…7 At these levels of hypoperfusion, severe damage to the microvasculature and blood-brain barrier may increase the risk of hemorrhage. 8 Our results are in line with recent studies, where VLCBV was associated with PH. 1,9 In addition, revascularization may also promote reperfusion injury.…”

Section: Discussionsupporting

confidence: 93%

Very Low Cerebral Blood Volume Predicts Parenchymal Hematoma in Acute Ischemic Stroke

Hermitte

Cho

Ozenne

et al. 2013

Stroke

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Background and Purpose— Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to explore the impact of early reperfusion and recanalization. Methods— The volume of cerebral tissue with CBV ≤2.5th percentile of the normal hemisphere was calculated within the acute diffusion-weighted imaging lesion. Hemorrhagic transformation was assessed on day 2 MRI according to the European Cooperative Acute Stroke Study II criteria. Recanalization and reperfusion were assessed on 3-hour follow-up MRI. Results— Of the 110 patients, hemorrhagic transformation occurred in 59 patients, including 7 PH. In univariate analysis, the acute National Institutes of Health Stroke Scale score ( P =0.002), acute diffusion-weighted imaging lesion volume ( P =0.02), and thrombolysis ( P =0.03), but not very low CBV ( P =0.52), were associated with hemorrhagic transformation. The volume of very low CBV was the only predictor of PH ( P =0.007). Early reperfusion and recanalization had no influence on either hemorrhagic transformation or PH. Conclusion— Very low CBV was the only independent predictor of PH in patients with acute stroke.

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Section: Discussionsupporting

confidence: 93%

Very Low Cerebral Blood Volume Predicts Parenchymal Hematoma in Acute Ischemic Stroke

Hermitte

Cho

Ozenne

et al. 2013

Stroke

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“…This result is substantiated by previous studies indicating that blunted nocturnal BP dip is more frequent in patients with hemorrhagic stroke (21). Additionally, reperfusion is a well-established predictor of hemorrhagic transformation, blood-brain barrier dysfunction, and thus loss of autoregulatory mechanisms (22,23). Put together, these data suggest that reverse dipping in the acute stage might be related to reperfusion injury in recanalyzed patients.…”

Section: Discussionsupporting

confidence: 81%

Nocturnal blood pressure dipping in acute ischemic stroke

et al. 2015

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Objectives -We aim to assess the impact of early nocturnal blood pressure (BP) variation in the functional outcome of patients after an acute ischemic stroke. Materials and methods -We included consecutive stroke patients treated with intravenous thrombolysis (IVrtPA) in a tertiary stroke center. BP measurements were performed at regular intervals throughout day and night during the first 48 h after stroke onset, and subjects were divided into four dipping categories (extreme dippers, dippers, non-dippers, and reverse dippers). Recanalization was assessed by transcranial color-coded Doppler and/or angiographic CT. Hemorrhagic transformation was evaluated at 24 h follow-up CT scan. Functional outcome was evaluated at 3 months after stroke using the modified Rankin Scale. Results -A total of 304 patients were included, mean age 72.80 AE 11.10 years. After 24 h of systolic BP monitoring, 30.59% were classified as reverse dippers, 39.14% as non-dippers, 19.10% as dippers, and 11.18% as extreme dippers. Multivariate analysis did not show an independent association of any dipping class with 3-month functional outcome. Hemorrhagic transformation was not uniform between dipping classes: 25.81% for reverse dippers, 14.29% for non-dippers, 15.52% for dippers, and 5.88% for extreme dippers, P = 0.033. Conclusions -Nocturnal BP dipping pattern is not associated with functional outcome at 3 months in acute stroke patients treated with IVrtPA. Hemorrhagic transformation was more frequent in reverse dippers.

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“…44 Nevertheless, late-onset intracranial hemorrhage is considered to be more related to the degree of ischemia and the development of collaterals rather than to the treatment methods applied. 45,46 Therefore, an evaluation of the hemorrhagic complications of microbubble-mediated sonothrombolysis within 24 hours is reasonable.…”

Section: Discussionmentioning

confidence: 99%

Microbubble-Mediated Sonothrombolysis Improves Outcome After Thrombotic Microembolism-Induced Acute Ischemic Stroke

Wang

Huang

et al. 2016

Stroke

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Microbubble-mediated sonothrombolysis is a promising treatment for cerebral microthrombi and is based on ultrasound driven cavitation of microbubbles that accelerate thrombolysis via localized mechanical stress on the thrombi. 17Background and Purpose-Microthrombi originating from disintegrated clots or formed in situ may account for the poor clinical improvement of acute ischemic stroke after recanalization therapy. We attempted to determine whether microbubble-mediated sonothrombolysis could dissolve platelet-rich and erythrocyte-rich microthrombi, thereby reducing their brain injury-causing potential. Methods-Platelet-and erythrocyte-rich microthrombosis were induced by periadventitial application of 5% ferric chloride or thrombin to mesenteric microvessels in 75 Sprague-Dawley rats. Acute ischemic stroke was induced by intracarotid injection of platelet-or erythrocyte-rich microthrombi in another 50 rats. Rats were randomly divided into control (CON), ultrasound (US), ultrasound and microbubble (US+MB), recombinant tissue-type plasminogen activator (r-tPA), and US+MB+r-tPA groups. The post-treatment mesenteric microvessel recanalization rates, cerebral infarct volumes, and neurological scores were determined. Results-The recanalization rates of platelet-and erythrocyte-rich microthrombi in mesenteric microvessels were higher (P<0.05), and the cerebral infarct volumes and neurological scores of rats with either microthrombi were lower in the US+MB group than in the CON group (P<0.01). The infarct volumes and neurological scores were greater in the r-tPA group than in the US+MB and US+MB+r-tPA groups after treatment of rats with platelet-rich microthrombi (P<0.05).In contrast, after treatment of rats with erythrocyte-rich microthrombi, the infarct volumes and neurological scores were similar in the r-tPA and US+MB groups, but smaller in the US+MB+r-tPA group (P<0.05). Conclusions-Microbubble-mediated sonothrombolysis improved the outcomes of microthrombi-induced acute ischemic stroke. Thus, this method may serve as an attractive adjunct to recanalization therapy for acute ischemic stroke.

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Blood–brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke

Cited by 394 publications

References 24 publications

Very Low Cerebral Blood Volume Predicts Parenchymal Hematoma in Acute Ischemic Stroke

Very Low Cerebral Blood Volume Predicts Parenchymal Hematoma in Acute Ischemic Stroke

Nocturnal blood pressure dipping in acute ischemic stroke

Microbubble-Mediated Sonothrombolysis Improves Outcome After Thrombotic Microembolism-Induced Acute Ischemic Stroke

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