Blood–brain barrier leakage increases with small vessel disease in acute ischemic stroke

Arba, F., Leigh, R., Inzitari, D., Warach, S. J., Luby, M. and Lees, K. R. (2017) Blood–brain barrier leakage increases with small vessel disease in acute ischemic stroke. Neurology, 89, pp. 2143-2150. (doi: 10.1212/WNL.0000000000004677) (PMID:29070665)

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Abstract

Objective: In patients with acute ischemic stroke, we aimed to investigate the relation between preexisting small vessel disease (SVD) and the amount of blood–brain barrier (BBB) leakage in ischemic and nonischemic area before IV thrombolysis. Methods: We retrospectively accessed anonymous patient-level data from the Stroke Imaging Repository and the Virtual International Stroke Trials Archive resources and included patients treated with IV thrombolysis with pretreatment MRI. We rated SVD features using validated qualitative magnetic resonance (MR) scales. Leakage of BBB was assessed with postprocessing of perfusion-weighted images. We evaluated associations between SVD features (individually and summed in a global SVD score) and BBB leakage using linear regression analysis, adjusting for major clinical confounders. Results: A total of 212 patients, mean age (±SD) 69.5 years (±16.1), 102 (48%) male, had available MR before IV thrombolysis. Evidence of BBB leakage was present in 175 (80%) and 205 (94%) patients in the ischemic and nonischemic area, respectively. Lacunar infarcts (β = 0.17, p = 0.042) were associated with BBB leakage in the ischemic area, and brain atrophy was associated with BBB leakage in both ischemic (β = 0.20, p = 0.026) and nonischemic (β = 0.27, p = 0.001) areas. Increasing SVD grade was independently associated with BBB leakage in both ischemic (β = 0.26, p = 0.007) and nonischemic (β = 0.27, p = 0.003) area. Conclusions: Global SVD burden is associated with increased BBB leakage in both acutely ischemic and nonischemic area. Our results support that SVD score has construct validity, and confirm a relation between SVD and BBB disruption also in patients with acute stroke.

Item Type:Articles
Additional Information:Authors: on behalf of the STIR/VISTA Imaging Collaboration.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Arba, Dr Francesco and Lees, Professor Kennedy and Luby, Ms Marie
Authors: Arba, F., Leigh, R., Inzitari, D., Warach, S. J., Luby, M., and Lees, K. R.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Neurology
Publisher:American Academy of Neurology
ISSN:0028-3878
ISSN (Online):1526-632X
Published Online:25 October 2017
Copyright Holders:Copyright © 2017 American Academy of Neurology
First Published:First published in Neurology 89:2143-2150
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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