Relation between stroke severity, patient characteristics and CT-perfusion derived blood-brain barrier permeability measurements in acute ischemic stroke

Abstract

PurposeIncreased blood-brain barrier permeability (BBBP) can result from ischemia. In this study the relation between stroke severity, patient characteristics and admission BBBP values measured with CT-perfusion (CTP) was investigated in acute ischemic stroke patients.MethodsFrom prospective data of the Dutch Acute Stroke Study 149 patients with a middle cerebral artery stroke and extended CTP were selected. BBBP values were measured in the penumbra and infarct core as defined by CTP thresholds, and in the contra-lateral hemisphere. The relation between stroke (severity) variables and patient characteristics, including early CT signs, dense vessel sign (DVS), time to scan and National Institute of Health Stroke Score (NIHSS), and BBBP parameters in penumbra and infarct core was quantified with regression analysis.ResultsEarly CT signs were related to higher BBBP values in the infarct core (B = 0.710), higher ipsi- to contra-lateral BBBP ratios (B = 0.326) and higher extraction ratios in the infarct core (B = 16.938). Females were found to have lower BBBP values in penumbra and infarct core (B = − 0.446 and − 0.776 respectively) and lower extraction ratios in the infarct core (B = − 10.463). If a DVS was present the ipsi- to contra-lateral BBBP ratios were lower (B = − 0.304). There was no relation between NIHSS or time to scan and BBBP values.ConclusionEarly CT signs are related to higher BBBP values in the infarct core, suggesting that only severe ischemic damage alters BBBP within the first hours after symptom onset.

Increased blood-brain barrier permeability in contralateral hemisphere predicts worse outcome in acute ischemic stroke after reperfusion therapy

“…Moreover, sex and infarct volume were also independently associated with BBBP in the contralateral mirror hypoperfusion region. Females had lower BBBP in our study, which was consistent with a previous study 9. An animal study demonstrated estradiol could prevent inflammation-induced tight junction breakdown by regulating inter-endothelial cell permeability and limiting the transmigration of lymphocyte 28.…”

Carotid Artery Stenting and Blood–Brain Barrier Permeability in Subjects with Chronic Carotid Artery Stenosis

“…They are, however, similar to the values reported in the Dutch Acute Stroke study of 149 subjects with acute stroke in which most scans were performed within 5 h of symptom onset [29]. Horsch et al did not observe any significant differences in PS between ipsi- and contralateral sides to the stroke area, as demonstrated in our study.…”

The effect of regadenoson on the integrity of the human blood–brain barrier, a pilot study

“…In contrast, Iodixanol is a nonionic hydrophilic compound without evidence that it is a substrate for any multi-drug resistance proteins/ABC transporters [34]. Both of these are considered water soluble imaging agents which have been shown to enter the brain only in regions where the blood-brain barrier is disrupted using CT and SPECT imaging [35–37]. …”