Severe Blood-Brain Barrier Disruption in Cardioembolic Stroke

被引：16
作者：
Liu, Chang [1 ]
Shi, Feina [1 ]
Chen, Zhicai [1 ]
Yan, Shenqiang [1 ]
Ding, Xinfa [2 ]
Lou, Min [1 ]
机构：
[1] Zhejiang Univ, Affiliated Hosp 2, Sch Med, Dept Neurol, Hangzhou, Zhejiang, Peoples R China
[2] Zhejiang Univ, Affiliated Hosp 2, Sch Med, Dept Radiol, Hangzhou, Zhejiang, Peoples R China
来源：
FRONTIERS IN NEUROLOGY | 2018年 / 9卷
基金：
中国国家自然科学基金;
关键词：
acute ischemic stroke; blood-brain barrier; cardioembolism; CT perfusion; stroke subtypes; ACUTE ISCHEMIC-STROKE; TISSUE-PLASMINOGEN ACTIVATOR; PERFUSION-CT ASSESSMENT; HEMORRHAGIC TRANSFORMATION; PERMEABILITY; THROMBOLYSIS; MULTICENTER; THERAPY; SUBTYPE; MODEL;
D O I：
10.3389/fneur.2018.00055
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
Background: Previous 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. Methods: This 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 (rPS(hypo)). 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 rPS(hypo) for CE. Logistic regression was used to identify independent predictors for CE. Results: A 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 rPS(hypo) was 65.5 (35.8-110.1)%. Ninety-seven (51.9%) patients were diagnosed as CE. ROC analysis revealed that the optimal rPS(hypo) threshold for CE was 86.71%. The value of rPS(hypo) and the rate of rPS(hypo)>86.71% were significantly higher in patients with CE than other stroke subtypes (p < 0.05), after adjusting for the potential confounds. Conclusion: The extent of BBB disruption is more severe in CE stroke than other stroke subtypes during the hyperacute stage.
引用
收藏
页数：6
相关论文
共 36 条
[1]   CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].
ADAMS, HP ;
BENDIXEN, BH ;
KAPPELLE, LJ ;
BILLER, J ;
LOVE, BB ;
GORDON, DL ;
MARSH, EE ;
KASE, CS ;
WOLF, PA ;
BABIKIAN, VL ;
LICATAGEHR, EE ;
ALLEN, N ;
BRASS, LM ;
FAYAD, PB ;
PAVALKIS, FJ ;
WEINBERGER, JM ;
TUHRIM, S ;
RUDOLPH, SH ;
HOROWITZ, DR ;
BITTON, A ;
MOHR, JP ;
SACCO, RL ;
CLAVIJO, M ;
ROSENBAUM, DM ;
SPARR, SA ;
KATZ, P ;
KLONOWSKI, E ;
CULEBRAS, A ;
CAREY, G ;
MARTIR, NI ;
FICARRA, C ;
HOGAN, EL ;
CARTER, T ;
GURECKI, P ;
MUNTZ, BK ;
RAMIREZLASSEPAS, M ;
TULLOCH, JW ;
QUINONES, MR ;
MENDEZ, M ;
ZHANG, SM ;
ALA, T ;
JOHNSTON, KC ;
ANDERSON, DC ;
TARREL, RM ;
NANCE, MA ;
BUDLIE, SR ;
DIERICH, M ;
HELGASON, CM ;
HIER, DB ;
SHAPIRO, RA .
STROKE, 1993, 24 (01) :35-41
[2]   The ASCOD Phenotyping of Ischemic Stroke (Updated ASCO Phenotyping) [J].
Amarenco, P. ;
Bogousslavsky, J. ;
Caplan, R. ;
Donnan, G. A. ;
Wolf, M. E. ;
Hennerici, M. G. .
CEREBROVASCULAR DISEASES, 2013, 36 (01) :1-5
[3]   Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT Perfusion [J].
Aviv, Richard I. ;
d'Esterre, Christopher D. ;
Murphy, Blake D. ;
Hopyan, Julia J. ;
Buck, Brian ;
Mallia, Gabriella ;
Li, Vivian ;
Zhang, Liying ;
Symons, Sean P. ;
Lee, Ting-Yim .
RADIOLOGY, 2009, 250 (03) :867-877
[4]   Determinants of the distribution and severity of hypoperfusion in patients with ischemic stroke [J].
Bang, O. Y. ;
Saver, J. L. ;
Alger, J. R. ;
Starkman, S. ;
Ovbiagele, B. ;
Liebeskind, D. S. .
NEUROLOGY, 2008, 71 (22) :1804-1811
[5]   A multicenter, randomized, controlled study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy (EXTEND-IA) [J].
Campbell, Bruce C. V. ;
Mitchell, Peter J. ;
Yan, Bernard ;
Parsons, Mark W. ;
Christensen, Soren ;
Churilov, Leonid ;
Dowling, Richard J. ;
Dewey, Helen ;
Brooks, Mark ;
Miteff, Ferdinand ;
Levi, Christopher ;
Krause, Martin ;
Harrington, Timothy J. ;
Faulder, Kenneth C. ;
Steinfort, Brendan S. ;
Kleinig, Timothy ;
Scroop, Rebecca ;
Chryssidis, Steve ;
Barber, Alan ;
Hope, Ayton ;
Moriarty, Maurice ;
McGuinness, Ben ;
Wong, Andrew A. ;
Coulthard, Alan ;
Wijeratne, Tissa ;
Lee, Andrew ;
Jannes, Jim ;
Leyden, James ;
Phan, Thanh G. ;
Chong, Winston ;
Holt, Michael E. ;
Chandra, Ronil V. ;
Bladin, Christopher F. ;
Badve, Monica ;
Rice, Henry ;
de Villiers, Laetitia ;
Ma, Henry ;
Desmond, Patricia M. ;
Donnan, Geoffrey A. ;
Davis, Stephen M. .
INTERNATIONAL JOURNAL OF STROKE, 2014, 9 (01) :126-132
[6]   Cerebral Blood Flow Is the Optimal CT Perfusion Parameter for Assessing Infarct Core [J].
Campbell, Bruce C. V. ;
Christensen, Soren ;
Levi, Christopher R. ;
Desmond, Patricia M. ;
Donnan, Geoffrey A. ;
Davis, Stephen M. ;
Parsons, Mark W. .
STROKE, 2011, 42 (12) :3435-U180
[7]  
Chaudhuri JR, 2013, IRAN J NEUROL, V12, P92
[8]   Dynamic Perfusion CT Assessment of the Blood-Brain Barrier Permeability: First Pass versus Delayed Acquisition [J].
Dankbaar, J. W. ;
Hom, J. ;
Schneider, T. ;
Cheng, S. -C. ;
Lau, B. C. ;
van der Schaaf, I. ;
Virmani, S. ;
Pohlman, S. ;
Dillon, W. P. ;
Wintermark, M. .
AMERICAN JOURNAL OF NEURORADIOLOGY, 2008, 29 (09) :1671-1676
[9]   Dynamic perfusion-CT assessment of early changes in blood brain barrier permeability of acute ischaemic stroke patients [J].
Dankbaar, J. W. ;
Hom, J. ;
Schneider, T. ;
Cheng, S. -C. ;
Bredno, J. ;
Lau, B. C. ;
van der Schaaf, I. C. ;
Wintermark, M. .
JOURNAL OF NEURORADIOLOGY, 2011, 38 (03) :161-166
[10]   Age- and anatomy-related values of blood-brain barrier permeability measured by perfusion-CT in non-stroke patients [J].
Dankbaar, J. W. ;
Hom, J. ;
Schneider, T. ;
Cheng, S. -C. ;
Lau, B. C. ;
van der Schaaf, I. ;
Virmani, S. ;
Pohlman, S. ;
Wintermark, M. .
JOURNAL OF NEURORADIOLOGY, 2009, 36 (04) :219-227
1234