Severe Blood–Brain Barrier Disruption in Cardioembolic Stroke

Abstract

BackgroundPrevious studies demonstrated that cardioembolism (CE) was prone to develop hemorrhagic transformation (HT), whereas hyper-permeability of blood–brain barrier (BBB) might be one reason for the development of HT. We, thus, aimed to investigate whether the BBB permeability (BBBP) was higher in CE stroke than other stroke subtypes in acute ischemic stroke (AIS) patients.MethodsThis study was a retrospective review of prospectively collected clinical and imaging database of AIS patients who underwent CT perfusion. Hypoperfusion was defined as Tmax >6 s. The average relative permeability-surface area product (rPS), reflecting the BBBP, was calculated within the hypoperfusion region (rPShypo). CE was diagnosed according to the international Trial of Org 10172 in Acute Stroke Treatment criteria. Receiver operating characteristics (ROC) curve analysis was used to determine predictive value of rPShypo for CE. Logistic regression was used to identify independent predictors for CE.ResultsA total of 187 patients were included in the final analysis [median age, 73 (61–80) years; 75 (40.1%) females; median baseline National Institutes of Health Stroke Scale score, 12 (7–16)]. Median rPShypo was 65.5 (35.8–110.1)%. Ninety-seven (51.9%) patients were diagnosed as CE. ROC analysis revealed that the optimal rPShypo threshold for CE was 86.71%. The value of rPShypo and the rate of rPShypo>86.71% were significantly higher in patients with CE than other stroke subtypes (p < 0.05), after adjusting for the potential confounds.ConclusionThe extent of BBB disruption is more severe in CE stroke than other stroke subtypes during the hyperacute stage.

Elevated high-sensitivity C-reactive protein levels predict poor outcomes among patients with acute cardioembolic stroke

“…Second, in the acute phase of cerebral infarction, the extent of brain injury and bloodbrain barrier (BBB) disruption may determine the degree of acute-phase inflammatory response. It has been confirmed that the degree of BBB destruction in CES patients is more serious than that in patients with other stroke subtypes (28), and this could be related to CRP levels (29). While these mechanisms may play a role in the increased CRP we observed, two studies have reported no differences in CRP levels among stroke subtypes (30,31).…”

ASPECTS-Based Attenuation Changes on CT Angiography as an Imaging Biomarker to Predict Hemorrhagic Transformation in Acute Ischemic Stroke

“…According to the literature, permeability maps, as the primary imaging assessment tool to evaluate HT, may underestimate permeability measurements [8, 9]. In addition, in some patients, reconstruction of these maps may not be possible due to the abnormal contrast curves caused by insufficient scan time [10, 11]. Recently, CT-based quantitative NWU has been described as an important imaging biomarker of malignant edema and lesion age in patients with AIS [12, 14].…”

“…In areas of low blood flow, contrast delivery is severely limited, and permeability measurements will be artificially reduced [8, 9]. In addition, the acquisition time for permeability imaging is long (at least 50–60 s), and 10–25% of patients are excluded because of motion artifacts or abnormal venous output function curves, resulting in failed reconstruction [10, 11].…”

Novel advanced imaging techniques for cerebral oedema

“…It involves using the Patlek method to calculate microvascular permeability metrics, transendothelial transfer constant (kPS) or permeability surface area product (PS, ml/min/100 g), based on time-density curves for each pixel ( 19 , 21 ). The use of relative permeability-surface area product (rPS = PS/CBF × 100) is of interest due to the correction for the potential influence of cerebral blood flow ( 19 , 20 , 67 ). In normal parenchyma, the permeability product is null for large molecules, such as iodine contrast.…”